The Association of Kidney Function with Disposition After Inpatient Noncardiac Surgery: A Population-Based Cohort Study
Bibliographic record
Abstract
Background: People with advanced kidney disease have more non-cardiac surgeries compared to the general population and a higher risk of postoperative cardiac events and death. However, whether post-operative length of hospitalization and discharge disposition vary with kidney function is not known. In this population-based cohort study from Alberta, Canada, we explored differences in postoperative length of stay (LOS), the number of days spent at home after surgery within 30 days (home time), and the discharge disposition according to preoperative kidney function. Methods: We identified adults undergoing inpatient surgery between April 2005 and February 2019, and categorized them by preoperative outpatient kidney function based on eGFR in mL/min/1.73m2: ≥ 60 (G1-2), 45-59 (G3a), 30-44 (G3b), 15-29 (G4), < 15 not receiving dialysis (G5ND) and receiving dialysis (G5D), and kidney transplant recipients (G1T-5T). Outcomes of interest were LOS, home time, and discharge disposition. We estimated associations between eGFR category and outcomes with multivariable generalized estimating equation (GEE) models to account for multiple surgeries clustered at the patient level. Results: We identified 927,560 inpatient surgeries in 666,770 people, with 55.9% of patients being female and median age of 57.4 years. People receiving dialysis (G5D) had the longest adjusted LOS at 17.9 days (95%CI 17.0, 18.7), more than 2 times greater than people with G1-2 kidney function (Adjusted Rate Ratio [ARR] of 2.21 [95%CI 2.10, 2.32]). This group also had the lowest home time, with an ARR of 0.69 (95%CI 0.67, 0.70) compared to people with G1-2 function. Most people were discharged home without support after surgery (82.8%), though people with G5D function were discharged to a facility with 24-hour nursing care nearly 4 times more often than the G1-2 group. There were graded increases in risks of these outcomes among adults with G3-G5ND kidney function. Conclusions: Patients with advanced kidney disease spend significantly more time in hospital after surgery, and less time at home. They are also more likely to be discharged with additional support at home or to a facility with nursing support. These findings may help inform perioperative resource planning and shared-decision making.
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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 | 0.001 | 0.002 |
| 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 | 0.000 |
| 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".