Key result
Dialysis patients undergoing emergency laparotomy had a significantly increased risk of major adverse cardiovascular events (HR 2.10; 95% CI 1.82-2.43; P<0.001), unlike kidney transplant recipients.
Why the study?
Emergency general surgery is associated with increased mortality and kidney failure contributes to this risk, but comparative outcomes between patients with kidney failure and the general population are lacking.
Does kidney failure increase the risk of major adverse cardiovascular events and all-cause mortality after emergency general surgery compared to the general population?
Cohort (n=691,064)
Yes
Does kidney failure increase the risk of major adverse cardiovascular events and all-cause mortality after emergency general surgery compared to the general population?
Hazard Ratio: 2.1 (95% CI 1.82–2.43)
p-value: p=<0.001
Dialysis patients, but not kidney transplant recipients, face a significantly higher risk of major adverse cardiovascular events following emergency general surgery compared to the general population.
Higher post-EGS mortality in kidney failure, worse with dialysis than transplant; leaves open whether optimized perioperative care improves outcomes.
BACKGROUND: Emergency general surgery (EGS) is associated with increased mortality, with kidney failure a contributing risk, but comparative outcomes between patients with kidney failure and the general population are lacking. METHODS: In this retrospective population-cohort study, data were analysed for all EGS procedures performed in England between 1 April 2004 and 31 March 2019. EGS was defined as partial colectomy, small bowel resection, cholecystectomy, appendicectomy, lysis of peritoneal adhesions, surgery for peptic ulcer, or laparotomy. The main outcome measure was major adverse cardiovascular events (MACEs) and all-cause mortality after surgery. RESULTS: From 691 064 procedures, 0.16 per cent (n = 1097) and 0.23 per cent (n = 1567) were performed on kidney transplant and dialysis recipients respectively. Laparotomy was the most frequent EGS procedure for kidney transplant (46 per cent of procedures, n = 507) and dialysis (45 per cent of procedures, n = 704) recipients, with the highest 30-day and 1-year mortality. In logistic regression analysis, both kidney failure cohorts had higher risk for experiencing MACEs in the postoperative interval after emergency laparotomy; within 3 months (dialysis; OR 2.44 (95 per cent c.i. 2.08 to 2.87), P < 0.001 and transplant; OR 2.05 (95 per cent c.i. 1.57 to 2.68), P < 0.001) and within 1 year (dialysis; OR 2.39 (95 per cent c.i. 2.06 to 2.77), P < 0.001 and transplant; OR 2.21 (95 per cent c.i. 1.76 to 2.77), P < 0.001); however, in a propensity-score-matched cohort, increased risk for MACEs was observed among dialysis patients after emergency laparotomy (HR 2.10 (95 per cent c.i. 1.82 to 2.43), P < 0.001) but not kidney transplant recipients (HR 1.17 (95 per cent c.i. 0.97 to 1.41), P = 0.096). CONCLUSION: Mortality after emergency surgery is higher for patients with kidney failure and dialysis is worse than kidney transplantation, with cardiovascular deaths more common than the general population.
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Anderson et al. (2022) conducted a cohort in Emergency general surgery (n=691,064). Kidney failure (dialysis or transplant) vs. General population was evaluated on Major adverse cardiovascular events (MACEs) and all-cause mortality after surgery (HR 2.10, 95% CI 1.82-2.43, p=<0.001). Dialysis patients undergoing emergency laparotomy had a significantly increased risk of major adverse cardiovascular events (HR 2.10; 95% CI 1.82-2.43; P<0.001), unlike kidney transplant recipients.
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