Secular trends in acute dialysis after elective major surgery-1995 to 2009
Secular trends in acute dialysis after elective major surgery-1995 to 2009
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DOI：
10.1503/cmaj.110895
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发表时间：
2012-08-07
影响因子：
14.6
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
--
作者：
Siddiqui, Nausheen F.;Coca, Steven G.;Garg, Amit X.
背景：急性肾损伤是择期大手术的严重并发症。急性透析用于维持最严重病例的生命。我们研究了择期大手术后急性透析的发生率和结果是否随时间推移而改变。方法：我们使用来自安大略全民医疗保健数据库的数据，研究1995年至2009年期间在118家医院进行择期大手术的所有连续患者。我们的主要结果是急性透析手术后14天内，手术后90天内死亡和慢性透析的患者谁没有恢复肾function.Results：共552 672例患者在研究期间进行了择期大手术，其中2231人接受急性透析。急性透析的发生率从1995年的0.2%（95%置信区间[CI] 0.15-0.2）稳步增加至2009年的0.6%（95% CI 0.6-0.7）。这一增长主要是在心脏和血管手术中。在接受急性透析的患者中，937例在手术后90天内死亡（42.0%，95% CI 40.0-44.1），90天生存率随时间无变化。在1294例接受急性透析并存活超过90天的患者中，352例需要慢性透析（27.2%，95%CI 24.8-29.7），随着时间的推移没有变化。解释：自1995年以来，心脏和血管手术后急性透析的使用大幅增加。研究重点是更好地预防和治疗围手术期急性肾损伤的干预措施是必要的。
Background: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time.Methods: We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed.