Postoperative non-fatal outcomes in people receiving chronic dialysis: a systematic review and meta-analysis of 42 studies and 78,805 patients
Notice bibliographique
Résumé
INTRODUCTION: People with end-stage kidney disease (ESKD) receiving chronic dialysis frequently undergo major surgery, but their absolute and relative risks of postoperative complications compared to non-dialysis patients are unclear. As a result, graded perioperative risk assessment and counselling remain difficult for chronic dialysis treatment for ESKD. The aim of this study was to estimate the risks of non-fatal postoperative outcomes in patients on chronic dialysis undergoing non-transplant surgery. METHODS: Two authors performed a systematic review of observational studies indexed in Embase and MEDLINE up to October 2018 that reported postoperative outcomes in chronic dialysis and non-dialysis patients undergoing major, non-transplant surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale. Summary level data on study characteristics, type of surgical procedure, patient demographics and comorbidities were extracted. Outcomes recorded included myocardial infarction, stroke, surgical site infection and sepsis. Random effects meta-analysis was performed to derive summary risk estimates and meta-regression was performed to explore heterogeneity. RESULTS: The systematic review included 42 studies involving 78,805 chronic dialysis and 9,984,469 non-dialysis patients undergoing orthopaedic, vascular, cardiothoracic, general and urological procedures. Cohort selection and outcome ascertainment were of good quality but comparability was poor. Summary, unadjusted risk estimates showed that, compared with people not on dialysis, those receiving chronic dialysis experienced increased risks of postoperative myocardial infarction (OR 3.4, 95%CI 2.4-4.8, I280%), stroke (OR 2.2, 95% CI 1.6-3.2, I291%), surgical site infection (OR 2.3, 95% CI 1.7-3.1, I294%) and sepsis (OR 3.5, 95% CI 2.4-5.0, I296%), as well as longer length of hospital stay (weighted mean difference 2.1 days, 95%CI 2.00-2.02) irrespective of type of surgery. When the meta-analysis was restricted to include only those studies that adjusted for age and comorbidities, there was an attenuation of the observed risks of postoperative myocardial infarction (OR 1.7, 95% CI 1.3-2.2 I297%), stroke (OR 1.1, 95% CI 1.0-1.2, I283%), surgical site infection (OR 1.3, 95% CI 1.2-1.5, I274%) and sepsis (OR 2.4, 95% CI 2.1-2.7, I277%). Weighted univariate meta-regression showed significant inverse linear relationships between study-level mean age and the excess risks of both myocardial infarction (slope -0.06, p=0.029) and stroke (slope -0.07, p= 0.031) for people on chronic dialysis. A similar relationship was observed between study level prevalence of ischemic heart disease and excess stroke risk (slope -0.02, p = 0.001), which was maintained in multivariable meta-regression (slope -0.02, p=0.006). Meta-regression did not demonstrate a significant variation in excess stroke risk with age difference between dialysis and non-dialysis study cohorts, highlighting the inherent heightened stroke risk in patients with ESKD on dialysis. No factors were found to be significantly related to excess risks of sepsis or surgical site infections. CONCLUSIONS: People receiving chronic dialysis have substantially increased risks of non-fatal postoperative complications across all surgical disciplines. This heightened risk may in part be explained by their older age and higher comorbid illness burden.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,014 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,013 | 0,029 |
| Bibliométrie | 0,007 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».