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Incidence and Mortality of Emergency General Surgery Conditions Among Solid Organ Transplant Recipients in Ontario, Canada: A Population-based Analysis.
Gomez, David; Acuna, Sergio A; Joseph Kim, S; Nantais, Jordan; Santiago, Robin; Calzavara, Andrew; Saskin, Refik; Baxter, Nancy N.
Afiliação
  • Gomez D; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Acuna SA; ICES, Toronto, ON, Canada.
  • Joseph Kim S; Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
  • Nantais J; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
  • Santiago R; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
  • Calzavara A; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Saskin R; ICES, Toronto, ON, Canada.
  • Baxter NN; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
Transplantation ; 107(3): 753-761, 2023 03 01.
Article em En | MEDLINE | ID: mdl-36117253
BACKGROUND: Emergency general surgery (EGS) conditions and their outcomes are perceived to be disproportionately high among solid organ transplant recipients (SOTRs). However, this has not been adequately investigated at a population level. We characterized the incidence and mortality of EGS conditions among SOTRs compared with nontransplant patients. METHODS: Data were collected through linked administrative population-based databases in Ontario, Canada. We included all adult SOTRs (kidney, liver, heart, and lung) who underwent transplantation between 2002 and 2017. We then identified posttransplantation emergency department visits for EGS conditions (appendicitis, cholecystitis, choledocolithiasis, perforated diverticulitis, incarcerated/strangulated hernias, small bowel obstruction, and perforated peptic ulcer). Age-, sex-, and year-standardized incidence rate ratios (SIRRs) were generated. Logistic regression models were used to evaluate association between transplantation status and 30 d mortality after adjusting for demographics, year, and comorbidities. RESULTS: Ten thousand seventy-three SOTRs and 12 608 135 persons were analyzed. SOTRs developed 881 EGS conditions (non-SOTRs: 552 194 events). The incidence of all EGS conditions among SOTR was significantly higher compared with the nontransplant patients [SIRR 3.56 (95% confidence interval [CI] 3.32-3.82)], even among those with high Aggregated Diagnosis Groups scores ( > 10) [SIRR 2.76 (95% CI 2.53-3.00)]. SOTRs were 1.4 times more likely to die at 30 d [adjusted odds ratio 1.44 (95% CI 1.08-1.91)] after an EGS event compared with nontransplant patients, predominantly amongst lung transplant recipients [adjusted odds ratio 3.28 (95% CI 1.72-6.24)]. CONCLUSIONS: The incidence of EGS conditions is significantly higher in SOTRs even after stratifying by comorbidity burden. This is of particular importance as SOTRs also have a higher likelihood of death after an EGS condition, especially lung transplant recipients.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Órgãos / Transplantados Tipo de estudo: Incidence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Revista: Transplantation Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Órgãos / Transplantados Tipo de estudo: Incidence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Revista: Transplantation Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá