Moghadamyeghaneh Zhobin, Chen Linda J, Alameddine Mahmoud, Jue Joshua S, Gupta Anupam K, Burke George, Ciancio Gaetano
Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, United States.
Can Urol Assoc J. 2017 Nov;11(11):E425-E430. doi: 10.5489/cuaj.4369.
We aimed to report the rate and short-term outcomes of patients undergoing re-operation following kidney transplant in the U.S.
The Nationwide Inpatient Sample (NIS) database was used to examine the clinical data of patients undergoing kidney transplant and re-operation during same the hospitalization from 2002-2012. Multivariate regression analysis was performed to compare outcomes of patients with and without re-operation.
We sampled a total of 35 058 patients who underwent kidney transplant. Of these, 770 (2.2%) had re-operation during the same hospitalization. Re-operation was associated with a significant increase in mortality (30.4% vs. 3%; adjusted odds ratio [AOR] 4.62; p<0.01), mean total hospital charges ($249 425 vs. $145 403; p<0.01), and mean hospitalization length of patients (18 vs. 7 days; p<0.01). The most common day of re-operation was postoperative Day 1. Hemorrhagic complication (64.2%) was the most common reason for re-operation, followed by urinary tract complications (9.9%) and vascular complications (3.6%). Preoperative coagulopathy (AOR 3.35; p<0.01) was the strongest predictor of need for re-operation, hemorrhagic complications (AOR 3.08; p<0.01), and vascular complications (AOR 2.50; p<0.01). Also, hypertension (AOR 1.26; p<0.01) and peripheral vascular disorders (AOR 1.25; p=0.03) had associations with hemorrhagic complications.
Re-operation after kidney transplant most commonly occurs on postoperative Day 1 and occurs in 2.2% of cases. It is associated with significantly increased mortality, hospitalization length, and total hospital charges. Hemorrhage is the most common complication. Preoperative coagulopathy is the strongest factor predicting the need for re-operation, vascular complications, and hemorrhagic complications.
我们旨在报告美国肾移植术后再次手术患者的发生率及短期预后。
利用全国住院患者样本（NIS）数据库，研究2002年至2012年期间在同一住院期间接受肾移植及再次手术患者的临床资料。进行多因素回归分析，比较再次手术和未再次手术患者的预后。
我们共抽取了35058例接受肾移植的患者。其中，770例（2.2%）在同一住院期间接受了再次手术。再次手术与死亡率显著增加相关（30.4%对3%；校正比值比[AOR]4.62；p<0.01）、平均总住院费用显著增加（249425美元对145403美元；p<0.01）以及患者平均住院时间显著延长（18天对7天；p<0.01）。再次手术最常见的时间是术后第1天。出血性并发症（64.2%）是再次手术最常见的原因，其次是泌尿系统并发症（9.9%）和血管并发症（3.6%）。术前凝血功能障碍（AOR 3.35；p<0.01）是再次手术需求、出血性并发症（AOR 3.08；p<0.01）和血管并发症（AOR 2.50；p<0.01）的最强预测因素。此外，高血压（AOR 1.26；p<0.01）和周围血管疾病（AOR 1.25；p=0.03）与出血性并发症有关。
肾移植术后再次手术最常见于术后第1天，发生率为2.2%。它与死亡率、住院时间和总住院费用显著增加相关。出血是最常见的并发症。术前凝血功能障碍是预测再次手术需求、血管并发症和出血性并发症的最强因素。
