Adverse outcomes after non urological surgeries in patients with chronic kidney disease: a propensity-score-matched study

Abstract

Yih-Giun Cherng,1,2 Chuen-Chau Chang,2–4 Chun-Chieh Yeh,5,6 Yung-Ho Hsu,7 Ta-Liang Chen,2,8,* Chien-Chang Liao2–4,9,10*1Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 2Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 3Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 4Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 5Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 6Department of Surgery, University of Illinois, Chicago, USA; 7Department of Nephrology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 8Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 9School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 10Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workObjective: To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD).Methods: Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008–2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD.Results: The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68–1.89), pneumonia (OR: 1.60, 95% CI: 1.48–1.73), stroke (OR: 1.34, 95% CI: 1.24–1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90–2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events.Conclusion: Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.Keywords: chronic kidney disease, surgery, outcome

Keywords

• chronic kidney disease
• surgery
• outcome