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

Abstract

Chien-Chang Liao,1– 5,* Chih-Chung Liu,1– 3 Yuan-Wen Lee,1– 3 Chuen-Chau Chang,1– 3 Chun-Chieh Yeh,6,7 Tzu-Hao Chang,8,9,* Ta-Liang Chen,2,3,10 Chao-Shun Lin1– 3 1Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 2Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 3Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 4Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 5School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 6Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 7Department of Surgery, University of Illinois, Chicago, IL, USA; 8Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; 9Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 10Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Chao-Shun Lin, Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan, Tel [phone] ext. 8310, Fax [phone], Email [email protected]; [email protected]: 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.Keywords: complications, dental scaling, mortality, hospitalization, stroke

Keywords

• complications
• dental scaling
• mortality
• hospitalization
• stroke