Chronic Kidney Disease Class Predicts Mortality After Abdominal Aortic Aneurysm Repair in Propensity-matched Cohorts From the Medicare Population
Chronic Kidney Disease Class Predicts Mortality After Abdominal Aortic Aneurysm Repair in Propensity-matched Cohorts From the Medicare Population
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DOI：
10.1097/sla.0000000000001519
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发表时间：
2016-08-01
影响因子：
9
通讯作者：
Patel, Virendra I.
中科院分区：
文献类型：
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作者：
Aranson, Nathan J.;Lancaster, Robert T.;Patel, Virendra I.
简介：慢性肾脏病 (CKD) 可以预测腹主动脉瘤 (AAA) 修复术后的死亡率。很少有研究能够充分根据 CKD 严重程度对结果进行分层。本研究评估 CKD 严重程度对 AAA 修复后生存的影响。方法：在 Medicare 数据库中回顾性识别 2006 年至 2007 年接受 AAA 修复的患者，并按 CKD 分级如下：正常（CKD 1 和 2 级）、中度（CKD 3 级）和重度（CKD 4 和 5 级）。根据临床因素和手术类型进行倾向匹配（30:1），以获得匹配良好的比较队列。主要结局是 30 天死亡率和长期死亡率；次要结局包括住院时间和费用。结果：总共纳入 47,715 名患者（96.7% 正常，1.88% 中度，1.65% 重度）。倾向匹配针对队列之间的差异进行了校正。中度（5.7% vs 正常 2.5%；P < 0.01）和重度（9.9% vs 正常 1.8%；P < 0.01）组的 30 天死亡率较高。住院时间随着 CKD 严重程度的增加而增加（正常 4.4 +/- 3.7 天 vs 中度 CKD 6.5 +/- 4.2 天；P < 0.01/4.7 +/- 3.8 天正常 vs 重度 CKD 9.1 +/- 4.5 天；P < 0.01），费用也一样（正常 23 +/- 14K 美元 vs 中度 25 +/- 16K 美元；P < 0.01） /$22 +/- 11K 正常 vs $29 +/- 22K 严重；P < 0.01)。三年生存率有利于正常队列（80% vs 64% 中等；对数等级 P < 0.01 /82% 正常 vs 44% 重度；对数等级 P < 0.01）。结论：在倾向匹配队列中，CKD 严重程度是 AAA 修复后围手术期死亡率和长期生存的重要预测因子。 30 天死亡率增加 5 倍，3 年生存率增加 44%，表明大多数严重 CKD 患者禁忌进行选择性 AAA 修复。
Introduction: Chronic kidney disease (CKD) predicts mortality after abdominal aortic aneurysm (AAA) repair. Few studies are adequately powered to stratify outcomes by CKD severity. This study assesses the effect of CKD severity on survival after AAA repair.Methods: Patients who underwent AAA repair from 2006 to 2007 were retrospectively identified in the Medicare database and stratified by CKD class as follows: normal (CKD class 1 and 2), moderate (CKD class 3), and severe (CKD class 4 and 5). Propensity matching (30: 1) by clinical factors and procedure type was performed to derive well-matched comparative cohorts. Primary outcomes were 30-day and long-term mortality; secondary outcomes included hospital length of stay and cost.Results: A total of 47,715 patients were included (96.7% normal, 1.88% moderate, and 1.65% severe). Propensity matching was corrected for differences between cohorts. Thirty-day mortality was higher in moderate (5.7% vs normal 2.5%; P < 0.01) and severe (9.9% vs normal 1.8%; P < 0.01) groups. Hospital length of stay increased with CKD severity (4.4 +/- 3.7 days normal vs 6.5 +/- 4.2 days moderate CKD; P < 0.01/4.7 +/- 3.8 days normal vs 9.1 +/- 4.5 days severe CKD; P < 0.01) as did cost ($23 +/- 14K normal vs $25 +/- 16K moderate; P < 0.01 /$22 +/- 11K normal vs $29 +/- 22K severe; P < 0.01). Three-year survival favored the normal cohort (80% vs 64% moderate; log rank P < 0.01 /82% normal vs 44% severe; log rank P < 0.01).Conclusions: CKD severity is an important predictor of perioperative mortality and long-term survival after AAA repair in propensity-matched cohorts. The 5-fold increase in 30-day mortality and 44% in 3-year survival suggest that elective AAA repair is contraindicated in most severe CKD patients.