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Lower eGFR Leads to More Major Surgeries: Study with 1,455,512 Patients

MAJOR surgery is more likely for individuals with kidney disease compared with people who have normal kidney function. This is according to the results of a new population-based study by researchers who investigated how often people with kidney disease have surgery and if the frequency is affected by the stage of kidney disease.

The study enrolled 1,455,512 adults with a median age of 52 years and 57% of whom were female; the individuals were placed into one of six categories based on their estimated glomerular filtration rate (eGFR). Most of the cohort (84.5%) had an eGFR of at least 60 mL/min/1.73m2 and thus were in group G1–2, and 0.1% of patients had chronic dialysis. Throughout the study, 241,989 (16.6%) patients had surgery that required them to stay at the hospital for at least 24 hours. Laparoscopic cholecystectomy was performed most often, followed by total hip arthroplasty and hysterectomy. Dr Tyrone G. Harrison, first author of the study from University of Calgary, Calgary, Canada, explained the aim of the study: “We need to understand more about this population and how they do after surgery so that we can try and optimise their perioperative experience.” The patients were followed up by the researchers for approximately 7 years.

In the group who had an eGFR of ≥60 mL/min/1.73m2 (G1–2), the adjusted incidence rates for major surgery in males and females were 18.4 and 24.4 procedures per 1,000 person-years for patients aged <65 years, respectively, and 53.5 and 56.2 per 1,000 person-years for patients aged >65 years, respectively. In the group whose kidney function was much lower with an eGFR of <15 mL/min/1.73m2 and were undergoing dialysis (G5D), the adjusted incidence rates for male and female patients <65 years old were 243.8 and 212.8 per 1,000 person-years, respectively, and for those >65 years old, 163.1 and 152.2 per 1,000 person-years, respectively.

The results have led experts in the field to consider future actions when performing surgery on patients with kidney disease. Dr Donald A. Maloney, from the McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, USA, said: “If the findings are corroborated, one might advocate for more cautious approaches to meet the surgical needs in this population, including fewer outpatient procedures and possibly earlier referral for procedures that can be scheduled and carefully performed.”