Postoperative Outcomes After Gastrointestinal Surgery in Patients Receiving Chronic Kidney Replacement Therapy: A Population-based Cohort Study.

Autor:	Palamuthusingam D; Metro North Kidney Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, Australia.; Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.; School of Medicine, Griffith University, Southport, Queensland, Australia., Hawley CM; Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.; Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Australasian Kidney Trials Network (AKTN), University of Queensland, St Lucia, Queensland, Australia., Pascoe EM; Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia., Johnson DW; Australasian Kidney Trials Network (AKTN), University of Queensland, St Lucia, Queensland, Australia.; Translational Research Institute, Brisbane, Australia., Palamuthusingam P; Department of Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia., Boudville N; Medical School, University of Western Australia, Stirling Highway, Perth, Western Australia.; Sir Charles Gairdner Hospital, Hospital Ave, Nedlands Western Australia., Jose MD; Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia.; School of Medicine, University of Tasmania, Tasmania, Australia., Cross NB; Department of Nephrology, Te Whatu Ora Waitaha Canterbury, Christchurch Hospital, Christchurch, New Zealand.; Senior Clinical Lecturer, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.; Chief Medical Officer, New Zealand Clinical Research, New Zealand., Fahim M; School of Medicine, Griffith University, Southport, Queensland, Australia.; Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Metro North Health Service, Butterfield Street, Herston, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Mar 01; Vol. 279 (3), pp. 462-470. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1097/SLA.0000000000006179
Abstrakt:	Objective: This study evaluated the postoperative mortality and morbidity outcomes following the different subtypes of gastrointestinal (GI) surgery over a 15-year period. Background: Patients receiving chronic kidney replacement therapy (KRT) experience higher rates of general surgery compared with other surgery types. Contemporary data on the types of surgeries and their outcomes are lacking. KRT was defined as patients requiring chronic dialysis (hemodialysis or peritoneal dilaysis) or having a functioning kidney transplant long-term. Methods: All incident and prevalent patients aged greater than 18 years identified in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry as receiving chronic KRT were linked with jurisdictional hospital admission datasets between January 1, 2000 until December 31, 2015. Patients were categorized by their KRT modality [hemodialysis (HD), peritoneal dialysis (PD), home hemodialysis (HHD), and kidney transplant (KT)]. GI surgeries were categorized as upper gastrointestinal (UGI), bowel (small and large bowel), anorectal, hernia surgery, cholecystectomy, and appendicectomy. The primary outcome was the rates of the different surgeries, estimated using Poisson models. Secondary outcomes were risks of 30-day/in-hospital postoperative mortality risk and nonfatal outcomes and were estimated using logistic regression. Independent predictors of 30-day mortality were examined using comorbidity-adjusted Cox models. Results: Overall, 46,779 patients on chronic KRT were linked to jurisdictional hospital datasets, and 9,116 patients were identified as having undergone 14,540 GI surgeries with a combined follow-up of 76,593 years. Patients on PD had the highest rates of GI surgery (8 per 100 patient years), with hernia surgery being the most frequent. Patients on PD also had the highest risk of 30-day postoperative mortality following the different types of GI surgery, with the risk being more than 2-fold higher after emergency surgery compared with elective procedures. Infective postoperative complications were more common than cardiac complications. This study also observed a U-shaped association between body mass index (BMI) and mortality, with a nadir in the 30 to 35 kg/m 2 group. Conclusions: Patients on chronic KRT have high rates of GI surgery and morbidity, particularly in those who receive PD, are older, or are either underweight or moderately obese. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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