Differences in Postoperative Disposition by Kidney Disease Severity: A Population-Based Cohort Study
Notice bibliographique
Résumé
RATIONALE & OBJECTIVE: People with advanced kidney disease undergo more noncardiac operations compared with the general population, with a higher risk of perioperative cardiac events and death. However, little is known about the associations between severity of preoperative kidney dysfunction with postoperative length of hospitalization and discharge disposition; these were the focus of this study. STUDY DESIGN: Population-based retrospective cohort. SETTING & PARTICIPANTS: Adults from Alberta, Canada, undergoing inpatient major noncardiac surgery between April 2005 and February 2019. EXPOSURE: Categorical preoperative outpatient estimated glomerular filtration rate (eGFR) or kidney failure status. OUTCOME: Length of stay (LOS), days alive at home after surgery within 30 and 90 days, and discharge disposition location. ANALYTICAL APPROACH: Associations were estimated with unadjusted and adjusted generalized estimating equation models. RESULTS: We identified 927,560 inpatient surgeries in 666,770 people (55.9% female; median age, 57.4 years). People receiving dialysis had the longest LOS (11 days [95% CI, 6-29]), 2 times greater than that among people with normal kidney function (adjusted incidence rate ratio [IRR], 2.21 [95% CI, 2.10-2.32]). This group also had the fewest days alive at home within the first 30 days after surgery, with an IRR of 0.69 (95% CI, 0.67-0.70) compared with people with normal eGFR. The majority of people (82.8%) were discharged home without nursing support after surgery, though people receiving dialysis were discharged to a facility with 24-hour nursing care nearly 4 times more often. There were graded increases in risks of these outcomes with lower levels of kidney function. LIMITATIONS: Many people did not have preoperative kidney function assessed, reflecting standard clinical practice in the general population. CONCLUSIONS: After major surgery, people with kidney disease spend more time recovering in hospital and have less independence from postdischarge nursing supports than otherwise similar patients who have normal or near normal kidney function. These differences were more pronounced for those with the most severe stages of kidney disease. PLAIN-LANGUAGE SUMMARY: People with kidney disease have surgery more frequently, with worse outcomes, compared with others in the general population. However, little is known about how long they spend in hospital afterward and whether they will be discharged home or to other facilities. To understand this more, we examined nearly 1 million surgeries performed in Alberta, Canada. Compared with people who have normal kidney function and are undergoing surgery, people with the most advanced kidney disease spent more than 2 times longer in hospital and were more likely to be discharged to long-term care facilities instead of being discharged to their homes. Future research is needed to understand the factors that predict who will experience prolonged hospitalization and to develop interventions to enable earlier discharge for people with kidney disease.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| 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 source (Gemma direct ou Codex distillé), 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 ».