Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.
Am J Kidney Dis
; 77(3): 365-375.e1, 2021 03.
Article
em En
| MEDLINE
| ID: mdl-33039431
ABSTRACT
RATIONALE & OBJECTIVE:
Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function. STUDYDESIGN:
Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016. SETTING &PARTICIPANTS:
Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort. EXPOSURE Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m2 with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.OUTCOME:
Major surgery defined as surgery requiring admission to the hospital for at least 24 hours. ANALYTICALAPPROACH:
Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.RESULTS:
1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.LIMITATIONS:
Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.CONCLUSIONS:
People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos Operatórios
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Taxa de Filtração Glomerular
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Falência Renal Crônica
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Canadá