Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study

• Published in: American journal of kidney diseases Vol. 77; no. 3; pp. 365 - 375.e1
• Main Authors: Harrison, Tyrone G., Ruzycki, Shannon M., James, Matthew T., Ronksley, Paul E., Zarnke, Kelly B., Tonelli, Marcello, Manns, Braden J., McCaughey, Deirdre, Schneider, Prism, Dixon, Elijah, Hartley, Rebecca L., Owen, Victoria S., Ma, Zhihai, Hemmelgarn, Brenda R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021
• Subjects: Adult; Aged; Aged, 80 and over; Alberta - epidemiology; cardiac surgery; chronic kidney disease (CKD); Cohort Studies; cohort study; Creatinine - metabolism; dialysis; estimated glomerular filtration rate (eGFR); Female; Glomerular Filtration Rate; Hospitalization; Humans; Incidence; Kidney disease; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - metabolism; Kidney Failure, Chronic - therapy; major surgery; Male; Middle Aged; musculoskeletal procedures; perioperative; Renal Dialysis; renal function; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - metabolism; Retrospective Studies; serum creatinine; Surgical Procedures, Operative - statistics & numerical data; surgical risk; vascular surgery; Alberta; Kidney disease; dialysis; major surgery; cohort study; surgical risk; chronic kidney disease (CKD); vascular surgery; serum creatinine; perioperative; musculoskeletal procedures; estimated glomerular filtration rate (eGFR); renal function; cardiac surgery; incidence
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2020.08.009

Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function. Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016. Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort. Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m2 with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period. Major surgery defined as surgery requiring admission to the hospital for at least 24 hours. Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated. 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery. Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included. People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function. [Display omitted]