Preoperative renal dysfunction and mortality after non-cardiac surgery

Area of Science:

• Nephrology
• Surgical Outcomes
• Public Health

Background:

• Chronic kidney disease (CKD) is a known risk factor for surgical complications.
• The impact of renal dysfunction on mortality after non-cardiac surgery requires further investigation.

Purpose of the Study:

• To investigate the association between preoperative renal dysfunction and postoperative mortality in non-cardiac surgery.
• To quantify the risk of death associated with varying degrees of reduced kidney function.

Main Methods:

• Analysis of two prospective observational studies: European Surgical Outcomes Study (EuSOS) and UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD).
• Utilized multivariable Cox proportional hazards models to examine the relationship between estimated glomerular filtration rate (eGFR) and postoperative mortality.

Main Results:

• Preoperative CKD (eGFR < 60 mL/min/1.73 m²) was present in 17.4% (EuSOS) and 21.6% (NCEPOD) of patients.
• Lower eGFR categories were associated with significantly increased adjusted hazard ratios (HRs) for death.
• Maximum risk observed with eGFR 15-29.9 mL/min/1.73 m² (HR 3.37 in EuSOS) and eGFR < 15 mL/min/1.73 m² (HR 3.40 in NCEPOD).

Conclusions:

• Renal dysfunction is a critical independent risk factor for mortality following non-cardiac surgery.
• A steep increase in death risk is evident for patients with moderate to severe kidney dysfunction (eGFR < 60 mL/min/1.73 m²).
• Preoperative assessment of eGFR is crucial for risk stratification in non-cardiac surgery patients.