Clinical and financial impact of chronic kidney disease in emergency general surgery operations

Abstract

Introduction: Chronic kidney disease is frequently encountered in clinical practice and often requires more intricate management strategies. However, its impact on outcomes of patients warranting emergency general surgery has not been well characterized. The present study examined the association of chronic kidney disease stage on in-hospital outcomes and readmission following emergency general surgery using a nationally representative cohort. Methods: The 2016–2018 Nationwide Readmissions Database was queried to identify all adult hospitalizations for 1 of 6 common emergency general surgery operations. Patients were stratified by severity of chronic kidney disease into stages 1–3, stages 4–5, end-stage renal disease, and others (non–chronic kidney disease). Regression models were used to examine factors associated with mortality, readmissions, and costs. Results: Of an estimated 985,101 patients undergoing emergency general surgery, 60,949 (6.2%) had a diagnosis of chronic kidney disease (1–3: 67.1%, 4–5: 11.5%, end-stage renal disease: 23.4%). Unadjusted rates of mortality increased with chronic kidney disease in a stepwise manner (2.1% in non–chronic kidney disease to 16.9 in end-stage renal disease, P < .001), as did 90-day readmissions (9.2% to 29.7%, respectively, P < .001). After adjustment, all stages of chronic kidney disease exhibited increases in risk-adjusted rates of mortality (range: 0.2% in chronic kidney disease 1–3 to 12.2% in end-stage renal disease, P < .001). Relative to non–chronic kidney disease, end-stage renal disease had the greatest cost burden for those undergoing small bowel resection (β +$83,600) and the least in cholecystectomy (+$30,400). Conclusion: Chronic kidney disease severity is associated with a stepwise increase in mortality, hospitalization costs, and 90-day readmissions. Our findings may better inform shared decision-making and have implications in benchmarking. Further studies for optimal management strategies in this high-risk group are needed.