Adverse outcomes after non urological surgeries in patients with chronic kidney disease: a propensity-score-matched study

Figures & data

Table 2 Characteristics of patients received nonurological surgeries with and without chronic kidney disease

	No CKD (N=35,643)		CKD (N=35,643)		P
	n	(%)	n	(%)
Age, years	n	(%)	n	(%)	1.0000
20–29	223	(0.6)	223	(0.6)
30–39	848	(2.4)	848	(2.4)
40–49	2789	(7.8)	2789	(7.8)
50–59	6968	(19.6)	6968	(19.6)
60–69	8816	(24.7)	8816	(24.7)
70–79	10,966	(30.8)	10,966	(30.8)
≥80	5033	(14.1)	5033	(14.1)
Sex					1.0000
Female	16,851	(47.3)	16,851	(47.3)
Male	18,792	(52.7)	18,792	(52.7)
Low income					1.0000
No	35,286	(99.0)	35,286	(99.0)
Yes	357	(1.0)	357	(1.0)
Operation in medical center					1.0000
No	19,684	(55.2)	19,684	(55.2)
Yes	15,959	(44.8)	15,959	(44.8)
Types of surgery					1.0000
Musculoskeletal	12,196	(34.2)	12,196	(34.2)
Digestive	9075	(25.5)	9075	(25.5)
Neurosurgery	3971	(11.1)	3971	(11.1)
Cardiovascular	2937	(8.2)	2937	(8.2)
Respiratory	742	(2.1)	742	(2.1)
Skin	480	(1.4)	480	(1.4)
Eye	394	(1.1)	394	(1.1)
Breast	263	(0.7)	263	(0.7)
Delivery, CS, abortion	111	(0.3)	111	(0.3)
Others	5474	(15.4)	5474	(15.4)
Types of anesthesia					1.0000
General	27,580	(77.4)	27,580	(77.4)
Epidural or spinal	8063	(22.6)	8063	(22.6)
Coexisting medical conditions
Hypertension	10,907	(30.6)	10,907	(30.6)	1.0000
Diabetes	7543	(21.2)	7543	(21.2)	1.0000
Cancer	4068	(11.4)	4068	(11.4)	1.0000
Mental disorders	3863	(10.8)	3863	(10.8)	1.0000
Peptic ulcer disease	2936	(8.2)	2936	(8.2)	1.0000
COPD	1858	(5.2)	1858	(5.2)	1.0000
Gout	1856	(5.2)	1856	(5.2)	1.0000
Anemia	1824	(5.1)	1824	(5.1)	1.0000
Atherosclerosis	903	(2.5)	903	(2.5)	1.0000
Pneumonia	602	(1.7)	602	(1.7)	1.0000
Asthma	554	(1.6)	554	(1.6)	1.0000
Osteoporosis	434	(1.2)	434	(1.2)	1.0000
Liver cirrhosis	353	(1.0)	353	(1.0)	1.0000
Angina	372	(1.0)	372	(1.0)	1.0000
Heart failure	303	(0.9)	303	(0.9)	1.0000
Venereal disease	244	(0.7)	244	(0.7)	1.0000
Parkinson’s disease	223	(0.6)	223	(0.6)	1.0000
Myocardial infarction	93	(0.3)	93	(0.3)	1.0000
Alcohol-related illness	96	(0.3)	96	(0.3)	1.0000
Peripheral vascular disease	67	(0.2)	67	(0.2)	1.0000
Atrial fibrillation	38	(0.1)	38	(0.1)	1.0000
Pulmonary tuberculosis	36	(0.1)	36	(0.1)	1.0000
Epilepsy	28	(0.1)	28	(0.1)	1.0000
Psoriasis	49	(0.1)	49	(0.1)	1.0000
SLE	27	(0.1)	27	(0.1)	1.0000
Hypothyroidism	30	(0.1)	30	(0.1)	1.0000
Number of hospitalizations					1.0000
0	18,344	(51.5)	18,344	(51.5)
1	8903	(25.0)	8903	(25.0)
2	3749	(10.5)	3749	(10.5)
≥3	4647	(13.0)	4647	(13.0)
Number of emergency visits					1.0000
0	15,573	(43.7)	15,573	(43.7)
1	8719	(24.5)	8719	(24.5)
2	4342	(12.2)	4342	(12.2)
≥3	7009	(19.7)	7009	(19.7)

Abbreviations: CKD, chronic kidney disease; SLE, systemic lupus erythematosus.

Table 1 Characteristics of patients received nonurological surgeries with and without chronic kidney disease

	No CKD (N=489,436)		CKD (N=122,359)		P
	n	(%)	n	(%)
Age, years					<0.0001
20–29	4736	(1.0)	1184	(1.0)
30–39	14,960	(3.1)	3740	(3.1)
40–49	39,760	(8.1)	9940	(8.1)
50–59	88,208	(18.0)	22,052	(18.0)
60–69	115,976	(23.7)	28,994	(23.7)
70–79	152,162	(31.1)	35,206	(28.8)
≥80	73,634	(15.0)	21,243	(17.4)
Sex					1.0000
Female	229,976	(47.0)	57,494	(47.0)
Male	259,460	(53.0)	64,865	(53.0)
Low income					<0.0001
No	479,230	(97.9)	115,838	(94.7)
Yes	10,206	(2.1)	6521	(5.3)
Operation in medical center					<0.0001
No	292,981	(59.9)	68,148	(55.7)
Yes	196,455	(40.1)	54,211	(44.3)
Types of surgery					<0.0001
Musculoskeletal	11,539	(2.4)	3661	(3.0)
Digestive	8131	(1.7)	907	(0.7)
Neurosurgery	176,298	(36.0)	34,909	(28.5)
Cardiovascular	22,034	(4.5)	3577	(2.9)
Respiratory	14,006	(2.9)	26,981	(22.1)
Skin	126,124	(25.8)	25,499	(20.8)
Eye	6525	(1.3)	313	(0.3)
Breast	60,306	(12.3)	10,836	(8.9)
Delivery, CS, abortion	6535	(1.3)	2325	(1.9)
Others	57,938	(11.8)	13,351	(10.9)
Types of anesthesia					<0.0001
General	350,831	(71.7)	97,402	(79.6)
Epidural or spinal	138,605	(28.3)	24,957	(20.4)
Coexisting medical conditions
Hypertension	156,299	(31.9)	50,963	(41.7)	<0.0001
Diabetes	72,099	(14.7)	45,126	(36.9)	<0.0001
Anemia	21,626	(4.4)	30,086	(24.6)	<0.0001
Mental disorders	81,935	(16.7)	25,427	(20.8)	<0.0001
Peptic ulcer disease	54,820	(11.2)	23,675	(19.4)	<0.0001
COPD	61,406	(12.6)	17,760	(14.5)	<0.0001
Cancer	71,000	(14.5)	17,038	(13.9)	<0.0001
Atherosclerosis	23,342	(4.8)	15,708	(12.8)	<0.0001
Gout	25,172	(5.1)	14,300	(11.7)	<0.0001
Pneumonia	18,230	(3.7)	13,380	(10.9)	<0.0001
Heart failure	9213	(1.9)	12,342	(10.1)	<0.0001
Angina	15,391	(3.1)	7887	(6.5)	<0.0001
Asthma	27,408	(5.6)	7493	(6.1)	<0.0001
Liver cirrhosis	12,169	(2.5)	5406	(4.4)	<0.0001
Myocardial infarction	4073	(0.8)	4502	(3.7)	<0.0001
Osteoporosis	17,870	(3.7)	4316	(3.5)	0.0383
Parkinson’s disease	10,891	(2.2)	3608	(3.0)	<0.0001
Venereal disease	10,779	(2.2)	2785	(2.3)	0.1170
Peripheral vascular disease	4583	(0.9)	2742	(2.2)	<0.0001
Pulmonary tuberculosis	4671	(1.0)	2337	(1.9)	<0.0001
Alcohol-related illness	7233	(1.5)	2204	(1.8)	<0.0001
Atrial fibrillation	3834	(0.8)	1763	(1.4)	<0.0001
Epilepsy	3167	(0.7)	1563	(1.3)	<0.0001
Systemic lupus erythematosus	847	(0.2)	1521	(1.2)	<0.0001
Psoriasis	3331	(0.7)	1245	(1.0)	<0.0001
Hypothyroidism	2159	(0.4)	885	(0.7)	<0.0001
Number of hospitalizations					<0.0001
0	296,852	(60.7)	29,300	(24.0)
1	105,368	(21.5)	24,751	(20.2)
2	43,012	(8.8)	19,178	(15.7)
≥3	44,204	(9.0)	49,130	(40.2)
Number of emergency visits					<0.0001
0	258,654	(52.9)	27,654	(22.6)
1	114,014	(23.3)	22,986	(18.8)
2	54,457	(11.1)	18,017	(14.7)
≥3	62,311	(12.7)	53,702	(43.9)

Abbreviation: CKD, chronic kidney disease.

Table 3 Risk of postoperative complications and mortality for surgical patients with preoperative CKD

	No CKD (N=35,643)		CKD (N=35,643)		Risk of outcomes
Postoperative outcomes	Events	%	Event	%	OR	(95% CI)^a
30-day in-hospital mortality	346	1.0	733	2.1	2.17	(1.90–2.47)
Postoperative complications
Septicemia	1818	5.1	3037	8.5	1.78	(1.68–1.89)
Stroke	1374	3.9	1785	5.0	1.34	(1.24–1.44)
Pneumonia	1141	3.2	1761	4.9	1.60	(1.48–1.73)
Urinary tract infection	1382	3.9	1497	4.2	1.09	(1.01–1.17)
Acute myocardial infarction	363	1.0	360	1.0	0.99	(0.85–1.15)
Postoperative bleeding	235	0.7	275	0.8	1.17	(0.98–1.40)
Pulmonary embolism	50	0.1	32	0.1	0.64	(0.41–1.00)
ICU stay	6301	17.7	7732	21.7	1.38	(1.32–1.43)
Medical expenditure, USD^b	3938±5195		4598±5700		p<0.0001
Length of hospital stay, days^b	11.0±16.5		13.2±17.8		p<0.0001

Note: ^aAdjusted for age, sex, low income, operation in medical center, types of anesthesia, types of surgery, and coexisting medical conditions. ‡Mean±SD.

Abbreviations: CI, confidence interval; CKD, chronic kidney disease; ICU, intensive care unit; OR, odds ratio.

Table 4 Stratified analysis for the risk of postoperative adverse events in patients with and without CKD

		n	Postoperative adverse events^a
			Events	Incidence, %	OR	(95% CI)
Age 20–29 years	No CKD	223	9	4.0	1.00	(reference)
	CKD	223	21	9.4	2.65	(1.15–6.11)
Age 30–39 years	No CKD	848	26	3.1	1.00	(reference)
	CKD	848	67	7.9	3.02	(1.85–4.93)
Age 40–49 years	No CKD	2789	191	6.9	1.00	(reference)
	CKD	2789	296	10.6	1.66	(1.37–2.02)
Age 50–59 years	No CKD	6968	571	8.2	1.00	(reference)
	CKD	6968	930	13.4	1.77	(1.58–1.98)
Age 60–69 years	No CKD	8816	1034	11.7	1.00	(reference)
	CKD	8816	1567	17.8	1.66	(1.52–1.81)
Age 70–79 years	No CKD	10,966	1878	17.1	1.00	(reference)
	CKD	10,966	2530	23.1	1.48	(1.38–1.58)
Age ≥80 years	No CKD	5033	1231	24.5	1.00	(reference)
	CKD	5033	1472	29.3	1.30	(1.18–1.42)
Female	No CKD	16,851	2043	12.1	1.00	(reference)
	CKD	16,851	3001	17.8	1.62	(1.52–1.73)
Male	No CKD	18,792	2897	15.4	1.00	(reference)
	CKD	18,792	3882	20.7	1.47	(1.39–1.55)
0 Medical condition	No CKD	10,549	1195	11.3	1.00	(reference)
	CKD	10,549	1894	18.0	1.76	(1.62–1.90)
1 Medical condition	No CKD	14,282	1951	13.7	1.00	(reference)
	CKD	14,282	2732	19.1	1.52	(1.42–1.62)
2 Medical conditions	No CKD	8016	1233	15.4	1.00	(reference)
	CKD	8016	1610	20.1	1.40	(1.29–1.52)
3 Medical conditions	No CKD	2276	442	19.4	1.00	(reference)
	CKD	2276	504	22.1	1.19	(1.03–1.38)
≥4 Medical conditions	No CKD	520	119	22.9	1.00	(reference)
	CKD	520	143	27.5	1.30	(0.97–1.74)
0 Hospitalization	No CKD	18,344	2101	11.5	1.00	(reference)
	CKD	18,344	2878	15.7	1.47	(1.38–1.57)
1 Hospitalization	No CKD	8903	1194	13.4	1.00	(reference)
	CKD	8903	1756	19.7	1.63	(1.50–1.77)
2 Hospitalizations	No CKD	3749	596	15.9	1.00	(reference)
	CKD	3749	883	23.6	1.67	(1.49–1.88)
≥3 Hospitalizations	No CKD	4647	1049	22.6	1.00	(reference)
	CKD	4647	1366	29.4	1.46	(1.32–1.60)
0 Emergency visit	No CKD	15,573	1674	10.8	1.00	(reference)
	CKD	15,573	2281	14.7	1.45	(1.36–1.56)
1 Emergency visit	No CKD	8719	1222	14.0	1.00	(reference)
	CKD	8719	1713	19.7	1.54	(1.42–1.67)
2 Emergency visits	No CKD	4342	662	15.3	1.00	(reference)
	CKD	4342	979	22.6	1.67	(1.49–1.87)
≥3 Emergency visits	No CKD	7009	1382	19.7	1.00	(reference)
	CKD	7009	1910	27.3	1.56	(1.44–1.69)

Note: ^aAdverse events include stroke, pneumonia, urinary tract infection, septicemia, and 30-day in-hospital mortality.

Abbreviations: CI, confidence interval; CKD, chronic kidney disease; OR, odds ratio.

Table S1 Factors associated with adverse events after nonurological surgeries in patients with chronic kidney disease (N=35643)^a

		OR	(95% CI)
Age, years	20–29	1.00	(reference)
	30–39	0.83	(0.49–1.40)
	40–49	1.14	(0.70–1.84)
	50–59	1.35	(0.84–2.15)
	60–69	1.84	(1.16–2.94)
	70–79	2.55	(1.60–4.07)
	≥80	3.65	(2.28–5.83)
Sex	Female	1.00	(reference)
	Male	1.09	(1.03–1.15)
Operation in medical center	No	1.13	(1.06–1.19)
	Yes	1.00	(reference)
Types of surgery	Musculoskeletal	3.39	(2.07–5.54)
	Digestive	5.27	(3.22–8.62)
	Neurosurgery	8.45	(5.16–13.8)
	Cardiovascular	8.03	(4.89–13.2)
	Respiratory	6.19	(3.68–10.4)
	Skin	4.89	(2.85–8.39)
	Eye	1.00	(reference)
	Breast	3.02	(1.56–5.84)
	Delivery, CS, abortion	3.87	(1.58–9.52)
	Others	2.73	(1.66–4.50)
Types of anesthesia	Epidural or spinal	1.00	(reference)
	General	1.23	(1.14–1.33)
Myocardial infarction	Yes vs no	2.17	(1.41–3.32)
Alcohol-related illness	Yes vs no	1.88	(1.14–3.10)
Parkinson’s disease	Yes vs no	1.45	(1.08–1.94)
Epilepsy	Yes vs no	3.97	(1.77–8.92)
Diabetes	Yes vs no	1.15	(1.07–1.23)
Number of hospitalizations	0	1.00	(reference)
	1	1.18	(1.10–1.26)
	2	1.38	(1.25–1.51)
	≥3	1.74	(1.58–1.91)
Number of emergency visits	0	1.00	(reference)
	1	1.27	(1.18–1.36)
	2	1.37	(1.25–1.50)
	≥3	1.47	(1.36–1.60)

Note: ^aAdverse events include stroke, pneumonia, urinary tract infection, septicemia, and 30-day in-hospital mortality.

Abbreviations: CI, confidence interval; OR, odds ratio.