心血管疾病和慢性肾脏疾病对大手术后长期死亡率的综合影响

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-05 DOI:10.1016/j.amjsurg.2025.116239

Nader Zamani , Sherene E. Sharath , Panos Kougias

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引用次数: 0

摘要

目的是表征心血管疾病（CVD）和慢性肾脏疾病（CKD）对大手术后长期死亡率的相互作用。方法：我们使用VA公司数据仓库和手术质量改进计划对1991年至2018年接受高风险手术的患者进行了一项全国性回顾性队列研究。术前暴露包括CVD（心绞痛、CHF、心肌梗死、中风、外周动脉疾病及相关手术史）和CKD III-V期。主要结局是长期死亡率。结果共纳入514057例手术。调整后，CVD和CKD III期（HR 1.38, 95% CI: 1.35-1.42）、IV期（HR 1.91, 95% CI: 1.83-2.01）和V期（HR 2.70, 95% CI: 2.59-2.81）之间的相互作用逐渐导致死亡风险增加。结论在大手术的背景下，考虑到基线肾功能不全程度，将CVD和CKD相互联系起来解释更为准确。

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Combined influence of cardiovascular disease and chronic kidney disease on long-term mortality following major operations

Introduction

The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.

Methods

We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.

Results

514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.

Conclusions

In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.