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学会・委員会企画

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第59回・2014年・神戸
 

Preoperative Renal Dialysis and Risk of Postoperative Adverse Events in Patients with Diabetes: A Nationwide Population-based Retrospective Cohort Study

演題番号 : GI-10-1-3

Yi-Chun Chou:1、Chien-Chang Liao:2、Ta-Liang Chen:2

1:Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan、2:School of Medicine, Taipei Medical University, Taipei, Taiwan

 

Background: To identify preoperative risk factors and risk assessment for 30-day postoperative in-hospital mortality in surgical patients with diabetes.
Methods: Using reimbursement claims from Taiwan’s National Health Insurance system, we performed a nationwide retrospective cohort study of 339,053 patients with diabetes mellitus undergoing major surgeries between 2004 and 2010. Preoperative renal dialysis (included hemodialysis and peritoneal dialysis) within 24 months was identified as major exposure. We compared the 30-day postoperative complications, mortality, and consumption of medical resources between diabetic patients with and without preoperative renal dialysis. Odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative adverse events associated with renal dialysis were calculated with the adjustment for sociodemographics, coexisting medical conditions, types of surgery and anesthesia in the multivariate logistic regressions.
Results: Among patients with diabetes, preoperative renal dialysis was associated with postoperative pneumonia (OR=1.44, 95% CI=1.34-1.54), septicemia (OR=2.02, 95% CI=1.94-2.11), stroke (OR=1.36, 95% CI=1.27-1.46), and in-hospital mortality (OR=2.55, 95% CI=2.33-2.79). Patients with renal dialysis had increased use of intensive care unit (OR=1.37, 95% CI=1.32-1.43), prolonged length of hospital stay (OR=1.75, 95% CI=1.68-1.81), and increased medical expenditure (OR=1.67, 95% CI=1.61-1.74).
Discussion: Our study focused on surgical patients with diabetes that was limited to lack of detailed information of sociodemographics, lifestyle, and biomedical measure.
Conclusion: This retrospective cohort study suggests preoperative renal dialysis was associated with 30-day postoperative adverse events in diabetic patients.

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