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Kidney Week

Abstract: SA-PO1126

The Association of Kidney Function with Disposition After Inpatient Noncardiac Surgery: A Population-Based Cohort Study

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Harrison, Tyrone, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Scory, Tayler D., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Graham, Michelle M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

People with advanced kidney disease have more non-cardiac surgeries compared to the general population and a higher risk of postoperative cardiac events and death. However, whether post-operative length of hospitalization and discharge disposition vary with kidney function is not known. In this population-based cohort study from Alberta, Canada, we explored differences in postoperative length of stay (LOS), the number of days spent at home after surgery within 30 days (home time), and the discharge disposition according to preoperative kidney function.

Methods

We identified adults undergoing inpatient surgery between April 2005 and February 2019, and categorized them by preoperative outpatient kidney function based on eGFR in mL/min/1.73m2: ≥ 60 (G1-2), 45-59 (G3a), 30-44 (G3b), 15-29 (G4), < 15 not receiving dialysis (G5ND) and receiving dialysis (G5D), and kidney transplant recipients (G1T-5T). Outcomes of interest were LOS, home time, and discharge disposition. We estimated associations between eGFR category and outcomes with multivariable generalized estimating equation (GEE) models to account for multiple surgeries clustered at the patient level.

Results

We identified 927,560 inpatient surgeries in 666,770 people, with 55.9% of patients being female and median age of 57.4 years. People receiving dialysis (G5D) had the longest adjusted LOS at 17.9 days (95%CI 17.0, 18.7), more than 2 times greater than people with G1-2 kidney function (Adjusted Rate Ratio [ARR] of 2.21 [95%CI 2.10, 2.32]). This group also had the lowest home time, with an ARR of 0.69 (95%CI 0.67, 0.70) compared to people with G1-2 function. Most people were discharged home without support after surgery (82.8%), though people with G5D function were discharged to a facility with 24-hour nursing care nearly 4 times more often than the G1-2 group. There were graded increases in risks of these outcomes among adults with G3-G5ND kidney function.

Conclusion

Patients with advanced kidney disease spend significantly more time in hospital after surgery, and less time at home. They are also more likely to be discharged with additional support at home or to a facility with nursing support. These findings may help inform perioperative resource planning and shared-decision making.