Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study

Harrison, Tyrone G.; Ruzycki, Shannon M.; James, Matthew T.; Ronksley, Paul E.; Zarnke, Kelly B.; Manns, Braden; McCaughey, Deirdre; Schneider, Prism; Dixon, Elijah; Hartley, Rebecca; Owen, Valerie M.; Ma, Zhuguo; Hemmelgarn, Brenda R.

doi:10.1053/j.ajkd.2020.08.009

Cited by 18 publications

(18 citation statements)

References 36 publications

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“…19 These findings build on a previous population-based retrospective study, which demonstrated that lower kidney function (estimated glomerular filtration rate) was associated with a higher incidence of surgery. 3 This is important because previous meta-analyses have demonstrated substantially higher odds of postoperative mortality and morbidity among patients on chronic KRT undergoing surgery compared with patients with normal kidney function. [4][5][6] This has implications for both the clinician and patient in terms of appreciating the unique aspects of KRT patients that influence postoperative outcomes, and from a health service planning perspective in relation to the excess medical resource utilization costs associated with higher rates of surgery, postoperative complications, and prolonged hospital stays.…”

Section: Discussionmentioning

confidence: 99%

Trends in Rates of Surgery and Postoperative Mortality Among Patients Receiving Chronic Kidney Replacement Therapy

et al. 2022

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Objective: To estimate the incidence and postoperative mortality rates of surgery, and variations by age, diabetes, kidney replacement therapy (KRT) modality, and time over a 15-year period. Background: Patients with kidney failure receiving chronic KRT (dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. Contemporary data on the incidence and types of surgery these patients undergo are lacking. Methods: This binational population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients were categorized by their KRT modality (hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplant) for each calendar year. Incidence rates for overall surgery and subtypes were estimated using Poisson models. Logistic regression was used to estimate 30-day/in-hospital mortality risk. Results: Overall, 46,497 patients over a median (interquartile range) follow-up of 6.3 years (3.5-10.2 years) underwent 81,332 surgeries. The median incidence rate of surgery remained stable over this period with a median of 14.9 surgeries per 100 patient-years. Annual incidence rate was higher in older people and those with diabetes mellitus. Patients receiving hemodialysis had a higher incidence rate of surgery compared with kidney transplant recipients (15.8 vs 10.0 surgeries per 100 patient-years, respectively). Overall adjusted postoperative mortality rates decreased by > 70% over the study period, and were lowest in kidney transplant recipients (1.7%, 95% confidence interval, 1.4-2.0). Postoperative mortality following emergency surgery was > 3-fold higher than elective surgery (8.4% vs 2.3%, respectively). Conclusions: Patients receiving chronic KRT have high rates of surgery and morbidity. Further research into strategies to mitigate perioperative risk remain a priority.

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Section: Discussionmentioning

confidence: 99%

Trends in Rates of Surgery and Postoperative Mortality Among Patients Receiving Chronic Kidney Replacement Therapy

et al. 2022

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“…Patients with kidney failure who are managed with dialysis often have multiple comorbidities and receive unique elements of care and, as a result, have unique challenges in the perioperative period. 36,37 We briefly describe 3 such examples.…”

Section: Perioperative Considerations For People With Kidney Failure Receiving Dialysismentioning

confidence: 99%

The Perioperative Surgical Home, Enhanced Recovery After Surgery and how integration of these models may improve care for medically complex patients

Harrison

Ronksley

James

et al. 2021

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Perioperative medicine is changing rapidly, and with this change comes the opportunity to improve upon current models of care delivery and integration within the health care system. Perioperative models of care are structured or conceptual arrangements for surgical patients before, during and after their surgery. Models of care such as the Perioperative Surgical Home and Enhanced Recovery After Surgery pathways are increasingly used to guide the structure of perioperative care delivery with an aim to improve patient outcomes and experience in Canadian settings. In this narrative review, we summarize the origins of these perioperative models of care. They are fundamentally different in scope and level of evidence. Both models have potential benefits and limitations to their broad implementation in our health care system. As currently developed, both models are limited in their application to patients with chronic disease. We discuss how these models of care can be used to develop integrated horizontal and vertical perioperative pathways in a Canadian setting. Such integration is a potential solution that will improve their applicability to patients with medically complex conditions and in times when health care systems are under pressure. We describe this approach using the example of patients with kidney failure receiving dialysis.

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“…Accurate perioperative risk estimation is especially important in patients with kidney failure, as they have a greater J o u r n a l P r e -p r o o f baseline risk of CV and other comorbid diseases 12,13 . Compared to those without kidney failure, they have upwards of sixteen times higher incidence of major surgery 14 , a four-to ten-fold higher odds of postoperative death 15 , and more frequent postoperative CV events and infectious complications 16 .…”

Section: Introductionmentioning

confidence: 99%

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

Harrison

Hemmelgarn²,

James³

et al. 2022

CJC Open

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Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study

Cited by 18 publications

References 36 publications

Trends in Rates of Surgery and Postoperative Mortality Among Patients Receiving Chronic Kidney Replacement Therapy

Trends in Rates of Surgery and Postoperative Mortality Among Patients Receiving Chronic Kidney Replacement Therapy

The Perioperative Surgical Home, Enhanced Recovery After Surgery and how integration of these models may improve care for medically complex patients

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

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