Kidney Week

Abstract: PO2413

Association of Kidney Function with Major Postoperative Events After Noncardiac Ambulatory Surgeries: A Population-Based Cohort Study

Session Information

• CKD: Qualitative and Quantitative Observational Studies
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Harrison, Tyrone, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Tyrone Harrison, MD

• Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Brenda Hemmelgarn,

• James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Matthew T. James,

• Manns, Braden J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Braden J. Manns,

• Tonelli, Marcello, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Marcello Tonelli,

• Brindle, Mary E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Mary E. Brindle,

• Ruzycki, Shannon M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Shannon M. Ruzycki,

• Zarnke, Kelly B., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Kelly B. Zarnke,

• Wick, James, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

James Wick,

• Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Paul E. Ronksley,

Background

Though people with chronic kidney disease (CKD) frequently receive outpatient surgical procedures, the associated risks of major perioperative outcomes is unknown. In this study, we estimated the association between estimated glomerular filtration rate (eGFR) and a composite of acute myocardial infarction (AMI) or death after ambulatory non-cardiac surgery.

Methods

This retrospective population-based cohort study used administrative health and laboratory data from Alberta, Canada, and included adults with measured preoperative kidney function undergoing ambulatory non-cardiac surgery between April 2005 and February 2017. We categorized participants into six eGFR categories (in mL/min/1.73m²) of ≥ 60 (G1-2), 45-59 (G3a), 30-44 (G3b), 15-29 (G4), < 15 not receiving dialysis (G5ND), and those receiving chronic dialysis (G5D). The odds of AMI or death within 30 days of surgery were estimated using multivariable generalized estimating equations. Secondary outcomes included the odds of hospitalization, emergency department (ED) and urgent care center (UCC) visits.

Results

We identified 543,160 procedures in 323,521 people with a median age of 66 years (IQR 56-76); 52% were female. Overall, 2,338 people (0.7%) died or had an AMI within 30 days of surgery. Compared with the G1-2 category, the adjusted odds ratio (OR) of death or AMI increased from 1.1 (95% Confidence interval [CI]: 1.0, 1.3) for G3a to 3.1 (CI: 2.6, 3.6) for G5D. The associations between eGFR and the independent components of this outcome were consistent for both death and AMI, and similar for 30-day hospitalization. ED and UCC visits within 30 days were frequent (17%), though similar across eGFR categories.

Conclusion

We found that ambulatory surgery was associated with a low overall risk of major postoperative events, though was significantly higher for people with CKD. This study may inform their perioperative shared decision-making and management, and suggests that more refined risk stratification approaches based on eGFR may be warranted.

Funding

• Government Support – Non-U.S.