Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 13;25(1):305.
doi: 10.1186/s12882-024-03753-1.

Association of chronic kidney disease with postoperative outcomes: a national surgical quality improvement program (NSQIP) multi-specialty surgical cohort analysis

Carlos Riveros  1 , Sanjana Ranganathan  1 , Yash B Shah  2 , Emily Huang  1 , Jiaqiong Xu  3 , Enshuo Hsu  3 , Michael Geng  4 , Siqi Hu  1 , Zachary Melchiode  1 , Brian J Miles  1 , Nestor Esnaola  5 , Zachary Klaassen  6 , Angela Jerath  7 , Christopher J D Wallis  8   9   10 , Raj Satkunasivam  11
Affiliations

Association of chronic kidney disease with postoperative outcomes: a national surgical quality improvement program (NSQIP) multi-specialty surgical cohort analysis

Carlos Riveros et al. BMC Nephrol. .

Abstract

Background: Chronic kidney disease (CKD) is associated with higher incidence of major surgery. No studies have evaluated the association between preoperative kidney function and postoperative outcomes across a wide spectrum of procedures. We aimed to evaluate the association between CKD and 30-day postoperative outcomes across surgical specialties.

Methods: We selected adult patients undergoing surgery across eight specialties. The primary study endpoint was major complications, defined as death, unplanned reoperation, cardiac complication, or stroke within 30 days following surgery. Secondary outcomes included Clavien-Dindo high-grade complications, as well as cardiac, pulmonary, infectious, and thromboembolic complications. Multivariable regression was performed to evaluate the association between CKD and 30-day postoperative complications, adjusted for baseline characteristics, surgical specialty, and operative time.

Results: In total, 1,912,682 patients were included. The odds of major complications (adjusted odds ratio [aOR] 2.14 [95% confidence interval (CI): 2.07, 2.21]), death (aOR 3.03 [95% CI: 2.88, 3.19]), unplanned reoperation (aOR 1.57 [95% CI: 1.51, 1.64]), cardiac complication (aOR 3.51 [95% CI: 3.25, 3.80]), and stroke (aOR 1.89 [95% CI: 1.64, 2.17]) were greater for patients with CKD stage 5 vs. stage 1. A similar pattern was observed for the secondary endpoints.

Conclusion: This population-based study demonstrates the negative impact of CKD on operative outcomes across a diverse range of procedures and patients.

Keywords: Chronic kidney disease; Postoperative outcomes; Quality improvement.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flow diagram
Fig. 2
Fig. 2
Association between CKD stage and major complications (along with its components) after multivariable analysis. CKD Stage 1 is the reference category. CKD: chronic kidney disease; aOR: adjusted odds ratio; CI: confidence interval
Fig. 3
Fig. 3
Association between CKD stage and secondary endpoints after multivariable analysis. CKD Stage 1 is the reference category. CKD: chronic kidney disease; CDHG: Clavien-Dindo high-grade; VTE: venous thromboembolism; aOR: adjusted odds ratio; CI: confidence interval
Fig. 4
Fig. 4
Association between CKD stage and major complications, subgrouped by surgical specialty. CKD Stage 1 is the reference category. aOR: adjusted odds ratio; CI: confidence interval
See this image and copyright information in PMC

References

    1. Levey AS, Coresh J, Tighiouart H, Greene T, Inker LA. Measured and estimated glomerular filtration rate: current status and future directions. Nat Rev Nephrol. 2020;16:51–64. 10.1038/s41581-019-0191-y 10.1038/s41581-019-0191-y - DOI - PubMed
    1. Stevens PE, Levin A. Kidney disease: improving global outcomes chronic kidney Disease Guideline Development Work Group, M. evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158:825–30. 10.7326/0003-4819-158-11-201306040-00007 10.7326/0003-4819-158-11-201306040-00007 - DOI - PubMed
    1. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389:1238–52. 10.1016/S0140-6736(16)32064-5 10.1016/S0140-6736(16)32064-5 - DOI - PubMed
    1. Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, Lee BJ, Perkins RM, Rossing P, Sairenchi T, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380:1662–73. 10.1016/S0140-6736(12)61350-6 10.1016/S0140-6736(12)61350-6 - DOI - PMC - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305. 10.1056/NEJMoa041031 10.1056/NEJMoa041031 - DOI - PubMed

LinkOut - more resources