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.