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Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()

BACKGROUND: There is a paucity of data examining the impact of advancing chronic kidney disease stages on outcomes following revascularization for acute limb ischemia. The present study examined the association of chronic kidney disease with in-hospital mortality, amputation, and resource utilizatio...

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Autores principales: Cho, Nam Yong, Mabeza, Russyan Mark, Lee, Cory, Verma, Arjun, Madrigal, Josef, Hadaya, Joseph, de Virgilio, Christian, Benharash, Peyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213817/
https://www.ncbi.nlm.nih.gov/pubmed/35755163
http://dx.doi.org/10.1016/j.sopen.2022.04.007
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author Cho, Nam Yong
Mabeza, Russyan Mark
Lee, Cory
Verma, Arjun
Madrigal, Josef
Hadaya, Joseph
de Virgilio, Christian
Benharash, Peyman
author_facet Cho, Nam Yong
Mabeza, Russyan Mark
Lee, Cory
Verma, Arjun
Madrigal, Josef
Hadaya, Joseph
de Virgilio, Christian
Benharash, Peyman
author_sort Cho, Nam Yong
collection PubMed
description BACKGROUND: There is a paucity of data examining the impact of advancing chronic kidney disease stages on outcomes following revascularization for acute limb ischemia. The present study examined the association of chronic kidney disease with in-hospital mortality, amputation, and resource utilization following revascularization for acute limb ischemia using a nationally representative cohort. METHODS: The 2016–2018 National Inpatient Sample was queried to identify all adult hospitalizations with lower extremity acute limb ischemia requiring surgical and/or endovascular interventions. Patients were grouped according to the presence of chronic kidney disease and its severity: no chronic kidney disease, chronic kidney disease 1–3 (chronic kidney disease stages 1 through 3), chronic kidney disease 4–5 (chronic kidney disease stages 4 through 5), and end-stage renal disease. Multivariable logistic and linear models were used to evaluate association of chronic kidney disease stage with outcomes of interest. RESULTS: Of an estimated 82,610 patients meeting study criteria, 14.8% had chronic kidney disease (chronic kidney disease 1–3: 63.4%, chronic kidney disease 4–5: 12.1%, end-stage renal disease: 24.5%). Compared to those with chronic kidney disease, chronic kidney disease patients were on average older, were more frequently female, and had a higher median Elixhauser Comorbidity Index. Increasing severity of chronic kidney disease was associated with a stepwise increase in unadjusted mortality rates (4.7% in no chronic kidney disease to 12.6% in end-stage renal disease, P < .001). Following risk adjustment, only end-stage renal disease was associated with increased odds of mortality (adjusted odds ratio 3.10, 95% confidence interval 2.28–4.22) and limb amputation (adjusted odds ratio 1.99, 95% confidence interval 1.59–2.48) compared to patients with no chronic kidney disease. Similarly, advancing chronic kidney disease stage conferred increased odds of prolonged length of stay and greater hospitalization costs. CONCLUSION: Advanced renal dysfunction demonstrated inferior perioperative outcomes and greater health care expenditures in the study population. These findings imply that quality improvement efforts in acute limb ischemia revascularization should target patients with chronic kidney disease 4–5 and end-stage renal disease.
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spelling pubmed-92138172022-06-23 Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()() Cho, Nam Yong Mabeza, Russyan Mark Lee, Cory Verma, Arjun Madrigal, Josef Hadaya, Joseph de Virgilio, Christian Benharash, Peyman Surg Open Sci Original Article BACKGROUND: There is a paucity of data examining the impact of advancing chronic kidney disease stages on outcomes following revascularization for acute limb ischemia. The present study examined the association of chronic kidney disease with in-hospital mortality, amputation, and resource utilization following revascularization for acute limb ischemia using a nationally representative cohort. METHODS: The 2016–2018 National Inpatient Sample was queried to identify all adult hospitalizations with lower extremity acute limb ischemia requiring surgical and/or endovascular interventions. Patients were grouped according to the presence of chronic kidney disease and its severity: no chronic kidney disease, chronic kidney disease 1–3 (chronic kidney disease stages 1 through 3), chronic kidney disease 4–5 (chronic kidney disease stages 4 through 5), and end-stage renal disease. Multivariable logistic and linear models were used to evaluate association of chronic kidney disease stage with outcomes of interest. RESULTS: Of an estimated 82,610 patients meeting study criteria, 14.8% had chronic kidney disease (chronic kidney disease 1–3: 63.4%, chronic kidney disease 4–5: 12.1%, end-stage renal disease: 24.5%). Compared to those with chronic kidney disease, chronic kidney disease patients were on average older, were more frequently female, and had a higher median Elixhauser Comorbidity Index. Increasing severity of chronic kidney disease was associated with a stepwise increase in unadjusted mortality rates (4.7% in no chronic kidney disease to 12.6% in end-stage renal disease, P < .001). Following risk adjustment, only end-stage renal disease was associated with increased odds of mortality (adjusted odds ratio 3.10, 95% confidence interval 2.28–4.22) and limb amputation (adjusted odds ratio 1.99, 95% confidence interval 1.59–2.48) compared to patients with no chronic kidney disease. Similarly, advancing chronic kidney disease stage conferred increased odds of prolonged length of stay and greater hospitalization costs. CONCLUSION: Advanced renal dysfunction demonstrated inferior perioperative outcomes and greater health care expenditures in the study population. These findings imply that quality improvement efforts in acute limb ischemia revascularization should target patients with chronic kidney disease 4–5 and end-stage renal disease. Elsevier 2022-05-11 /pmc/articles/PMC9213817/ /pubmed/35755163 http://dx.doi.org/10.1016/j.sopen.2022.04.007 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Cho, Nam Yong
Mabeza, Russyan Mark
Lee, Cory
Verma, Arjun
Madrigal, Josef
Hadaya, Joseph
de Virgilio, Christian
Benharash, Peyman
Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title_full Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title_fullStr Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title_full_unstemmed Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title_short Association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
title_sort association of chronic kidney disease with perioperative outcomes following acute lower limb revascularization()()()
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213817/
https://www.ncbi.nlm.nih.gov/pubmed/35755163
http://dx.doi.org/10.1016/j.sopen.2022.04.007
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