Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan.
Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan.
Int J Surg. 2022 Aug;104:106816. doi: 10.1016/j.ijsu.2022.106816. Epub 2022 Aug 6.
Chronic kidney disease is associated with perioperative mortality. However, outcomes of patients who perioperatively received acute dialysis have not been clarified. We aimed to determine risks for in-hospital death and functional decline following various surgeries with an acute dialysis requirement versus maintenance dialysis and non-dialysis.
We analyzed 22,857 patients who underwent major surgeries during hospitalization in Japan from 2018 until 2019 using an inpatient administrative claims database. Risks of overall death and functional decline assessed by Barthel index scores were determined with logistic regression models.
Among the propensity score-matched groups, mortality rates were 8.54% [95% confidence interval (CI) 7.92-9.17], 5.97% (95% CI 5.44-6.50), and 1.12% (95% CI 0.88-1.35) with an acute dialysis requirement, maintenance dialysis, and non-dialysis, respectively. The survivor rates with ≥20%-decline in Barthel index scores were 7.67% (95% CI 7.07-8.26), 8.56% (95% CI 7.93-9.19), and 3.48% (95% CI 3.07-3.89), respectively. Lower preoperative Barthel index scores were strongly associated with mortality independent of surgeries. Cardiac surgery, colorectal resection, esophagectomy, and gastrectomy led to higher mortality, while cardiac surgery, and orthopedic surgery were associated with higher risk of functional decline. In addition, mortality rates after hepatic lobectomy/cholecystectomy/pancreatectomy [odds ratio (OR) 3.09, 95% CI 1.61-5.91] and esophagectomy/gastrectomy (OR 2.65, 95% CI 1.68-4.38) were markedly higher with an acute dialysis requirement when compared with maintenance dialysis.
Perioperative acute dialysis requirements were associated with substantial risks for mortality and functional decline. Several types of surgeries led to even higher mortality rates for acute dialysis than maintenance dialysis.
慢性肾脏病与围手术期死亡率相关。然而，围手术期接受急性透析的患者的预后尚未明确。本研究旨在确定与维持透析和非透析相比，各种需要急性透析的手术与住院期间死亡和功能下降的风险。
我们使用住院患者行政索赔数据库，分析了 2018 年至 2019 年期间在日本接受主要手术的 22857 例患者。使用逻辑回归模型确定总体死亡率和由巴氏量表评分评估的功能下降风险。
在倾向评分匹配组中，需要急性透析、维持透析和非透析的死亡率分别为 8.54%（95%CI 7.92-9.17）、5.97%（95%CI 5.44-6.50）和 1.12%（95%CI 0.88-1.35）。巴氏量表评分下降≥20%的生存率分别为 7.67%（95%CI 7.07-8.26）、8.56%（95%CI 7.93-9.19）和 3.48%（95%CI 3.07-3.89）。较低的术前巴氏量表评分与手术无关，是死亡率的独立危险因素。心脏手术、结直肠切除术、食管癌切除术和胃癌切除术导致更高的死亡率，而心脏手术和骨科手术与更高的功能下降风险相关。此外，与维持透析相比，肝叶切除术/胆囊切除术/胰腺切除术（OR 3.09，95%CI 1.61-5.91）和食管癌切除术/胃癌切除术（OR 2.65，95%CI 1.68-4.38）的急性透析需求与更高的死亡率显著相关。
围手术期急性透析需求与死亡和功能下降的风险显著相关。几种类型的手术导致急性透析的死亡率甚至高于维持透析。
