Metro North Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
Ann Surg. 2022 Dec 1;276(6):1002-1010. doi: 10.1097/SLA.0000000000005694. Epub 2022 Sep 2.
To estimate the incidence and postoperative mortality rates of surgery, and variations by age, diabetes, kidney replacement therapy (KRT) modality, and time over a 15-year period.
Patients with kidney failure receiving chronic KRT (dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. Contemporary data on the incidence and types of surgery these patients undergo are lacking.
This binational population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients were categorized by their KRT modality (hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplant) for each calendar year. Incidence rates for overall surgery and subtypes were estimated using Poisson models. Logistic regression was used to estimate 30-day/in-hospital mortality risk.
Overall, 46,497 patients over a median (interquartile range) follow-up of 6.3 years (3.5-10.2 years) underwent 81,332 surgeries. The median incidence rate of surgery remained stable over this period with a median of 14.9 surgeries per 100 patient-years. Annual incidence rate was higher in older people and those with diabetes mellitus. Patients receiving hemodialysis had a higher incidence rate of surgery compared with kidney transplant recipients (15.8 vs 10.0 surgeries per 100 patient-years, respectively). Overall adjusted postoperative mortality rates decreased by >70% over the study period, and were lowest in kidney transplant recipients (1.7%, 95% confidence interval, 1.4-2.0). Postoperative mortality following emergency surgery was >3-fold higher than elective surgery (8.4% vs 2.3%, respectively).
Patients receiving chronic KRT have high rates of surgery and morbidity. Further research into strategies to mitigate perioperative risk remain a priority.
评估 15 年内手术的发病率和术后死亡率，并分析其随年龄、糖尿病、肾脏替代治疗（KRT）方式的变化而变化的情况。
接受慢性 KRT（透析或肾移植）的肾衰竭患者术后死亡和发病风险增加。目前缺乏这些患者接受手术的发病率和类型的相关数据。
本项澳新两国（澳大利亚和新西兰）人口队列研究通过澳大利亚和新西兰透析和移植（ANZDATA）登记处与司法管辖区住院数据集之间的关联数据，对所有接受慢性 KRT 的新发和现患患者进行了评估，这些患者在每个日历年内按 KRT 方式（血液透析、腹膜透析、家庭血液透析和肾移植）进行分类。使用泊松模型估计总体手术和亚型的发病率。使用逻辑回归估计 30 天/住院内死亡率风险。
在中位（四分位间距）6.3 年（3.5-10.2 年）的随访中，共有 46497 名患者接受了 81332 次手术。在此期间，手术的中位发病率保持稳定，中位数为每 100 名患者年 14.9 次手术。年龄较大和患有糖尿病的患者手术发病率较高。与肾移植受者相比，接受血液透析的患者手术发病率更高（分别为每 100 名患者年 15.8 次和 10.0 次手术）。在研究期间，总体术后调整死亡率下降了 70%以上，肾移植受者最低（1.7%，95%置信区间为 1.4%-2.0%）。急诊手术后的死亡率是择期手术的 3 倍以上（分别为 8.4%和 2.3%）。
接受慢性 KRT 的患者手术和发病率较高。进一步研究降低围手术期风险的策略仍是当务之急。
