Adverse outcomes after non urological surgeries in patients with chronic kidney disease: A propensity-score-matched study

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Abstract

Objective: To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods: Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results: The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68-1.89), pneumonia (OR: 1.60, 95% CI: 1.48-1.73), stroke (OR: 1.34, 95% CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion: Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.

Original languageEnglish
Pages (from-to)707-719
Number of pages13
JournalClinical Epidemiology
Volume11
DOIs
Publication statusPublished - Jan 1 2019

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Propensity Score
Chronic Renal Insufficiency
Odds Ratio
Confidence Intervals
Kidney Diseases
Hospital Mortality
Health Expenditures
Postoperative Care
National Health Programs
Epilepsy
Length of Stay
Sepsis
Pneumonia
Cohort Studies
Age Groups
Logistic Models
Stroke
Myocardial Infarction
Mortality

Keywords

  • Chronic kidney disease
  • Outcome
  • Surgery

ASJC Scopus subject areas

  • Epidemiology

Cite this

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title = "Adverse outcomes after non urological surgeries in patients with chronic kidney disease: A propensity-score-matched study",
abstract = "Objective: To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods: Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95{\%} confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results: The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95{\%} CI: 1.68-1.89), pneumonia (OR: 1.60, 95{\%} CI: 1.48-1.73), stroke (OR: 1.34, 95{\%} CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95{\%} CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion: Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.",
keywords = "Chronic kidney disease, Outcome, Surgery",
author = "Cherng, {Yih Giun} and Chang, {Chuen Chau} and Yeh, {Chun Chieh} and Hsu, {Yung Ho} and Chen, {Ta Liang} and Liao, {Chien Chang}",
year = "2019",
month = "1",
day = "1",
doi = "10.2147/CLEP.S219140",
language = "English",
volume = "11",
pages = "707--719",
journal = "Clinical Epidemiology",
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T1 - Adverse outcomes after non urological surgeries in patients with chronic kidney disease

T2 - A propensity-score-matched study

AU - Cherng, Yih Giun

AU - Chang, Chuen Chau

AU - Yeh, Chun Chieh

AU - Hsu, Yung Ho

AU - Chen, Ta Liang

AU - Liao, Chien Chang

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods: Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results: The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68-1.89), pneumonia (OR: 1.60, 95% CI: 1.48-1.73), stroke (OR: 1.34, 95% CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion: Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.

AB - Objective: To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods: Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results: The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68-1.89), pneumonia (OR: 1.60, 95% CI: 1.48-1.73), stroke (OR: 1.34, 95% CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion: Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.

KW - Chronic kidney disease

KW - Outcome

KW - Surgery

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JF - Clinical Epidemiology

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