Department of Medicine, Western University, London, Ontario.
CMAJ. 2012 Aug 7;184(11):1237-45. doi: 10.1503/cmaj.110895. Epub 2012 Jun 25.
Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time.
We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.
A total of 552,672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.
The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed.
急性肾损伤是择期大手术的严重并发症。急性透析用于支持最严重病例的生命。我们研究了择期大手术后急性透析的发生率和结局是否随时间而变化。
我们使用安大略省全民医疗保健数据库的数据，研究了 1995 年至 2009 年间 118 家医院的所有连续接受择期大手术的患者。我们的主要结局是手术 14 天内急性透析、手术 90 天内死亡以及未恢复肾功能的患者慢性透析。
在研究期间，共有 552672 名患者接受了择期大手术，其中 2231 名接受了急性透析。急性透析的发生率从 1995 年的 0.2%（95%置信区间[CI]0.15-0.2）稳步上升至 2009 年的 0.6%（95% CI 0.6-0.7）。这种增加主要发生在心脏和血管手术中。在接受急性透析的患者中，937 人在手术 90 天内死亡（42.0%，95% CI 40.0-44.1），随着时间的推移，90 天生存率没有变化。在接受急性透析并存活超过 90 天的 1294 名患者中，有 352 名需要慢性透析（27.2%，95% CI 24.8-29.7），随着时间的推移没有变化。
自 1995 年以来，心脏和血管手术后使用急性透析的情况大幅增加。需要研究侧重于更好地预防和治疗围手术期急性肾损伤的干预措施。
