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American Journal of Kidney Diseases

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study

  • Tyrone G. Harrison
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Shannon M. Ruzycki
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Matthew T. James
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Paul E. Ronksley
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Kelly B. Zarnke
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Marcello Tonelli
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Braden J. Manns
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Deirdre McCaughey
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Prism Schneider
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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  • Elijah Dixon
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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  • Rebecca L. Hartley
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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  • Victoria S. Owen
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Zhihai Ma
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Brenda R. Hemmelgarn
    Correspondence
    Address for Correspondence: Brenda R. Hemmelgarn, MD, PhD, Faculty of Medicine & Dentistry, 2J2.01 Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2R7.
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Published:October 08, 2020DOI:https://doi.org/10.1053/j.ajkd.2020.08.009

      Rationale & Objective

      Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function.

      Study Design

      Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016.

      Setting & Participants

      Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort.

      Exposure

      Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and <15 mL/min/1.73 m2 with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.

      Outcome

      Major surgery defined as surgery requiring admission to the hospital for at least 24 hours.

      Analytical Approach

      Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.

      Results

      1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.

      Limitations

      Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.

      Conclusions

      People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.

      Graphical abstract

      Index Words

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