POSTOPERATIVE OUTCOMES IN CHRONIC DIALYSIS PATIENTS: A META‐ANALYSIS OF 42 STUDIES AND 78,805 PATIENTS
Notice bibliographique
Résumé
Background: Chronic kidney disease is an independent risk factor for postoperative mortality, with an effect similar to that of diabetes mellitus or ischemic heart disease. However, the prognostic significance of dialysis‐dependence chronic kidney disease on perioperative outcomes, and its interaction with comorbid conditions is unclear.\n\nAim: The aim of this study was to estimate the excess risk of postoperative mortality in patients receiving chronic dialysis undergoing elective non‐transplant surgery compared to those with normal kidney function, and to examine the influence on comorbidities on mortality risk.\n\nMethods: Two authors independently performed a systematic review of studies published up to 2018 was conducted using MEDLINE, EMBASE, DARE, CDSR, NICE, NIHR HTA databases. Eligible studies reported postoperative outcomes in patients on chronic dialysis and patients with normal kidney function undergoing major non‐transplant surgery. Non‐dialysis chronic kidney disease patients were excluded. Risk of bias was assessed using the Newcastle‐Ottawa Scale. Mortality risk estimates over all studies and according to surgical discipline were obtained using random effects meta‐analysis Meta‐regression analysis was performed to explore heterogeneity and assess associations of mortality with age, and comorbidities including ischemic heart disease and diabetes mellitus. (PROSPERO CRD42017076565)\n\nResults: Forty‐two studies involving 78,805 chronic dialysis and 9,984,469 non‐dialysis patients undergoing orthopaedic, vascular, cardiothoracic, general and urological procedures were included. Cohort selection and outcome ascertainment were of good quality, but comparability was poor. Absolute mortality rate varied from 0%‐8·9% in chronic dialysis patients and 0%‐3·9% in patients with normal kidney function across surgical disciplines. Patients on dialysis had a greatly increased postoperative mortality risk compared to patients with normal kidney function following all types of elective surgery (odds ratio [OR] 5·70, 95% CI 4·63 – 7·01). Adjustment for age and comorbidity attenuated this risk (OR 3·13, 95% CI 2·91 ‐ 3·34 I 290%). There was an inverse linear relationship between excess mortality risk and study‐level mean age (slope ‐0·06; P = 0·001), diabetes prevalence (slope ‐0·02; p = 0·001) and ischemic heart disease (slope ‐0·01; p = 0·049).\n\nConclusions: Patients on chronic dialysis have a greatly increased postoperative mortality risk following elective surgery across all surgical disciplines, with the highest excess risk observed in those without other comorbidities. A comprehensive perioperative risk assessment and risk mitigation is required in patients on chronic dialysis.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».