Association of Kidney Function with Major Postoperative Events After Noncardiac Ambulatory Surgeries: A Population-Based Cohort Study
Bibliographic record
Abstract
Background: Though people with chronic kidney disease (CKD) frequently receive outpatient surgical procedures, the associated risks of major perioperative outcomes is unknown. In this study, we estimated the association between estimated glomerular filtration rate (eGFR) and a composite of acute myocardial infarction (AMI) or death after ambulatory non-cardiac surgery. Methods: This retrospective population-based cohort study used administrative health and laboratory data from Alberta, Canada, and included adults with measured preoperative kidney function undergoing ambulatory non-cardiac surgery between April 2005 and February 2017. We categorized participants into six eGFR categories (in mL/min/1.73m2) of ≥ 60 (G1-2), 45-59 (G3a), 30-44 (G3b), 15-29 (G4), < 15 not receiving dialysis (G5ND), and those receiving chronic dialysis (G5D). The odds of AMI or death within 30 days of surgery were estimated using multivariable generalized estimating equations. Secondary outcomes included the odds of hospitalization, emergency department (ED) and urgent care center (UCC) visits. Results: We identified 543,160 procedures in 323,521 people with a median age of 66 years (IQR 56-76); 52% were female. Overall, 2,338 people (0.7%) died or had an AMI within 30 days of surgery. Compared with the G1-2 category, the adjusted odds ratio (OR) of death or AMI increased from 1.1 (95% Confidence interval [CI]: 1.0, 1.3) for G3a to 3.1 (CI: 2.6, 3.6) for G5D. The associations between eGFR and the independent components of this outcome were consistent for both death and AMI, and similar for 30-day hospitalization. ED and UCC visits within 30 days were frequent (17%), though similar across eGFR categories. Conclusions: We found that ambulatory surgery was associated with a low overall risk of major postoperative events, though was significantly higher for people with CKD. This study may inform their perioperative shared decision-making and management, and suggests that more refined risk stratification approaches based on eGFR may be warranted. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".