Complications and Mortality After Surgery in Patients with Chronic Kidney Disease: A Retrospective Cohort Study Based on a Multicenter Clinical Database

Overview

Journal J Multidiscip Healthc

Publisher Dove Medical Press

Specialty Health Services

Date 2024 Jul 29

PMID 39070691

Authors

Chien-Chang Liao

Chih-Chung Liu

Yuan-Wen Lee

Chuen-Chau Chang

Chun-Chieh Yeh

Tzu-Hao Chang

Ta-Liang Chen

Chao-Shun Lin

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the postoperative complications and mortality among patients with chronic kidney disease.

Methods: Biochemical measurements, diagnosis codes for CKD and comorbid conditions for surgical patients aged ≥20 years were obtained from electronic medical records of three large hospitals in Taiwan in 2009-2017. We conducted this retrospective cohort study by using propensity score-matching methods to balance the baseline characteristics between CKD and non-CKD groups. The multiple logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of risks of primary outcome (included postoperative mortality) and secondary outcome (included postoperative infectious complications and non-infectious complications) associated with CKD.

Results: Among 31950 eligible surgical patients, the adjusted OR of in-hospital mortality in patients with CKD was 5.49 (95% CI 3.42-8.81) compared with that in non-CKD controls. The adjusted ORs of postoperative septicemia, pneumonia and cellulitis in patients with CKD were 5.90 (95% CI 2.12-16.5), 5.39 (95% CI 1.37-21.16), and 4.42 (95% CI 1.57-12.4), respectively, when compared with the non-CKD patients. CKD was also associated with postoperative stroke (OR 2.21, 95% CI 1.47-3.31).

Conclusion: Patients with CKD are at increased risk of postoperative stroke, infectious complications, and mortality. Our study implicated that it is crucial to improve the levels of hemoglobin and K+ in patients with CKD before surgery. Preventive strategies should be developed to improve clinical outcomes in these populations.

References

Girndt M, Sester U, Sester M, Kaul H, Kohler H . Impaired cellular immune function in patients with end-stage renal failure. Nephrol Dial Transplant. 1999; 14(12):2807-10. DOI: 10.1093/ndt/14.12.2807. View

Eckardt K, Berns J, Rocco M, Kasiske B . Definition and classification of CKD: the debate should be about patient prognosis--a position statement from KDOQI and KDIGO. Am J Kidney Dis. 2009; 53(6):915-20. DOI: 10.1053/j.ajkd.2009.04.001. View

Bijker J, Persoon S, Peelen L, Moons K, Kalkman C, Kappelle L . Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology. 2012; 116(3):658-64. DOI: 10.1097/ALN.0b013e3182472320. View

Dalrymple L, Go A . Epidemiology of acute infections among patients with chronic kidney disease. Clin J Am Soc Nephrol. 2008; 3(5):1487-93. PMC: 4571152. DOI: 10.2215/CJN.01290308. View

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

Tsukamoto M, Hitosugi T, Yokoyama T . Influence of Fasting Duration on Body Fluid and Hemodynamics. Anesth Prog. 2017; 64(4):226-229. PMC: 5715306. DOI: 10.2344/anpr-65-01-01. View

Harrison T, Ruzycki S, James M, Ronksley P, Zarnke K, Tonelli M . Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study. Am J Kidney Dis. 2020; 77(3):365-375.e1. DOI: 10.1053/j.ajkd.2020.08.009. View

Mathew A, Devereaux P, OHare A, Tonelli M, Thiessen-Philbrook H, Nevis I . Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int. 2008; 73(9):1069-81. DOI: 10.1038/ki.2008.29. View

Kuss O, Blettner M, Borgermann J . Propensity Score: an Alternative Method of Analyzing Treatment Effects. Dtsch Arztebl Int. 2016; 113(35-36):597-603. PMC: 5963493. DOI: 10.3238/arztebl.2016.0597. View

10.

. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020; 395(10225):709-733. PMC: 7049905. DOI: 10.1016/S0140-6736(20)30045-3. View

11.

Vestergaard S, Christiansen C, Thomsen R, Birn H, Heide-Jorgensen U . Identification of Patients with CKD in Medical Databases: A Comparison of Different Algorithms. Clin J Am Soc Nephrol. 2021; 16(4):543-551. PMC: 8092062. DOI: 10.2215/CJN.15691020. View

12.

Tonelli M, Wiebe N, Guthrie B, James M, Quan H, Fortin M . Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney Int. 2015; 88(4):859-66. DOI: 10.1038/ki.2015.228. View

13.

ODwyer M, Owen H, Torrance H . The perioperative immune response. Curr Opin Crit Care. 2015; 21(4):336-42. DOI: 10.1097/MCC.0000000000000213. View

14.

Dhondup T, Qian Q . Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif. 2017; 43(1-3):179-188. DOI: 10.1159/000452725. View

15.

Austin P . Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2010; 10(2):150-61. PMC: 3120982. DOI: 10.1002/pst.433. View

16.

Strebel S, Lam A, Matta B, Mayberg T, Aaslid R, Newell D . Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology. 1995; 83(1):66-76. DOI: 10.1097/00000542-199507000-00008. View

17.

Nunns G, Moore E, Chapman M, Moore H, Stettler G, Peltz E . The hypercoagulability paradox of chronic kidney disease: The role of fibrinogen. Am J Surg. 2017; 214(6):1215-1218. PMC: 5693753. DOI: 10.1016/j.amjsurg.2017.08.039. View

18.

Palamuthusingam D, Nadarajah A, Johnson D, Pascoe E, Hawley C, Fahim M . Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis. BMC Nephrol. 2021; 22(1):97. PMC: 7977605. DOI: 10.1186/s12882-021-02279-0. View

19.

Dalrymple L, Katz R, Kestenbaum B, de Boer I, Fried L, Sarnak M . The risk of infection-related hospitalization with decreased kidney function. Am J Kidney Dis. 2011; 59(3):356-63. PMC: 3288732. DOI: 10.1053/j.ajkd.2011.07.012. View

20.

Lee M, Saver J, Chang K, Liao H, Chang S, Ovbiagele B . Low glomerular filtration rate and risk of stroke: meta-analysis. BMJ. 2010; 341:c4249. PMC: 2948650. DOI: 10.1136/bmj.c4249. View