scholarly journals Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tyrone G. Harrison ◽  
Paul E. Ronksley ◽  
Matthew T. James ◽  
Shannon M. Ruzycki ◽  
Marcello Tonelli ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Kidney Failure ◽  
Surgical Procedure ◽  
Population Based ◽  
Perioperative Outcomes ◽  
Major Surgery ◽  
Future Research ◽  
Neurosurgical Procedures ◽  
Risk Of Death

Abstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type. Methods In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type. Results Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery. Conclusions After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.

scholarly journals POS-522 MORTALITY AND CARDIOVASCULAR EVENTS IN ADULTS WITH KIDNEY FAILURE AFTER MAJOR NON-CARDIAC SURGERY: A POPULATION-BASED COHORT STUDY

2021 ◽  
Vol 6 (4) ◽  
pp. S227
Author(s):  
T. HARRISON ◽  
P.E. Ronksley ◽  
M.T. James ◽  
S.M. Ruzycki ◽  
D. McCaughey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Kidney Failure ◽  
Cardiovascular Events ◽  
Population Based

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study

2020 ◽  
Author(s):  
Tyrone G. Harrison ◽  
Shannon M. Ruzycki ◽  
Matthew T. James ◽  
Paul E. Ronksley ◽  
Kelly B. Zarnke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Major Surgery ◽  
Estimated Gfr

scholarly journals Long-Term Outcome of Cardiac Surgery in 1,040 Liver Cirrhosis Patient　― Nationwide Population-Based Cohort Study ―

2017 ◽  
Vol 81 (4) ◽  
pp. 476-484 ◽  
Author(s):  
An-Hsun Chou ◽  
Tien-Hsing Chen ◽  
Chun-Yu Chen ◽  
Shao-Wei Chen ◽  
Chao-Wei Lee ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Liver Cirrhosis ◽  
Cohort Study ◽  
Population Based ◽  
Cirrhosis Patient ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Liver Cirrhosis Patient

scholarly journals Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e014508 ◽  
Author(s):  
Erika Frischknecht Christensen ◽  
Mette Dahl Bendtsen ◽  
Thomas Mulvad Larsen ◽  
Flemming Bøgh Jensen ◽  
Tim Alex Lindskou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Population Based ◽  
Ambulance Service ◽  
Annual Number ◽  
Adjusted Relative Risk ◽  
Risk Of Death ◽  
The North ◽  
Emergency Ambulance ◽  
Age And Sex

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

scholarly journals Risk of Kidney Failure in Patients With Cancer: A South Korean Population-Based Cohort Study

2021 ◽  
Author(s):  
Chang Seong Kim ◽  
Bongseong Kim ◽  
Sang Heon Suh ◽  
Tae Ryom Oh ◽  
Minah Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Failure ◽  
Population Based ◽  
Korean Population ◽  
South Korean ◽  
Patients With Cancer

scholarly journals Chronic post‐operative opioid use after open cardiac surgery: A Danish population‐based cohort study

2020 ◽  
Vol 65 (1) ◽  
pp. 47-57
Author(s):  
Kasper Bonnesen ◽  
Lone Nikolajsen ◽  
Henrik Bøggild ◽  
Per Hostrup Nielsen ◽  
Carl‐Johan Jacobsen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Population Based ◽  
Opioid Use ◽  
Danish Population

scholarly journals Influence of Mortality on Estimating the Risk of Kidney Failure in People with Stage 4 CKD

2019 ◽  
Vol 30 (11) ◽  
pp. 2219-2227 ◽  
Author(s):  
Pietro Ravani ◽  
Marta Fiocco ◽  
Ping Liu ◽  
Robert R. Quinn ◽  
Brenda Hemmelgarn ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Failure ◽  
Absolute Risk ◽  
Population Based ◽  
Comparison Standard ◽  
Risk Of Death ◽  
Failure Risk ◽  
Stage 4 ◽  
Standard Risk ◽  
Over Time

BackgroundMost kidney failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of kidney failure.MethodsUsing 2002–2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of kidney failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15–30 ml/min per 1.73 m2.ResultsOf the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed kidney failure and 53% died. The observed risk of the combined end point of death or kidney failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and >100% at 7.5 years. Censoring for death increasingly overestimated the risk of kidney failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria >300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%).ConclusionsKidney failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.

scholarly journals Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database

2020 ◽  
Vol 8 (2) ◽  
pp. e001351
Author(s):  
Chao-Shun Lin ◽  
Chuen-Chau Chang ◽  
Chun-Chieh Yeh ◽  
Yi-Cheng Chang ◽  
Ta-Liang Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Real World ◽  
Lower Risk ◽  
Randomized Clinical Trials ◽  
Medical Condition ◽  
Perioperative Outcomes ◽  
Major Surgery ◽  
Postoperative Intensive Care ◽  
Patients With Diabetes ◽  
Complications And Mortality

IntroductionLimited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methodsUsing a real-world database of Taiwan’s National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use.ResultsPatients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (p<0.0001) than non-use controls.ConclusionsAmong patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes.

scholarly journals All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Spinal Cord ◽  
2019 ◽  
Vol 58 (2) ◽  
pp. 157-164 ◽  
Author(s):  
A. Buzzell ◽  
◽  
J. D. Chamberlain ◽  
I. Eriks-Hoogland ◽  
K. Hug ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Clinical Care ◽  
Population Based ◽  
Future Research ◽  
Cord Injury ◽  
Specific Mortality ◽  
National Cohort

Abstract Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.

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