Gynecological surgery in patients with kidney failure on chronic kidney replacement therapy: A binational data linkage study of morbidity and mortality outcomes

IF 2.4 3区医学 Q2 OBSTETRICS & GYNECOLOGY International Journal of Gynecology & Obstetrics Pub Date : 2025-03-17 DOI:10.1002/ijgo.70064

Mina Khair, Dharmenaan Palamuthusingam, Carmel M. Hawley, Elaine M. Pascoe, Usama Shahid, David W. Johnson, Magid Fahim

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Abstract

Objective

This study evaluates postoperative outcomes of patients with kidney failure on chronic kidney replacement therapy after gynecological surgery.

Methods

This binational data-linkage study identified patients with kidney failure via the Australia and New Zealand Dialysis and Transplant Registry who underwent major gynecological surgeries between 2000 and 2015. The primary outcome was postoperative mortality. Secondary outcomes included infective, medical, and wound complications, transfusion requirement, intensive care unit (ICU) admissions, readmissions, length of stay, and dialysis/transplant-specific outcomes. Univariable and multivariable logistic and negative binomial regression models were used.

Results

Among the 403 patients included, 30.5% underwent abdominal hysterectomy, 19.1% vaginal hysterectomy and 50.4% ovarian surgery. Thirty-day mortality and morbidity rates were 1.2% (95% confidence interval [CI]: 0.5–3.0) and 30.8% (95% CI: 26.3–35.6), respectively. Compared with abdominal hysterectomy, vaginal hysterectomy was associated with fewer transfusions (adjusted odds ratios [aOR]: 0.40, 95% CI: 0.16–0.98), ICU admissions (aOR: 0.28, 95% CI: 0.09–0.80), and shorter stays (IRR: 0.74, 95% CI: 0.55–0.99). Of all kidney replacement therapies, postoperative mortality was highest in patients on peritoneal dialysis (6.9%, 95% CI: 1.2–24.2, P = 0.026). This cohort also required more transfusions (aOR: 2.84, 95% CI: 1.12–7.21) and had longer stays (IRR: 1.58, 95% CI: 1.07–2.33). Kidney transplant recipients had fewer ICU admissions (aOR: 0.22, 95% CI: 0.09–0.52) and shorter stays (IRR: 0.75, 95% CI: 0.58–0.96). Emergency admissions and older age correlated with poorer outcomes.

Conclusion

Patients on chronic kidney replacement therapy undergoing gynecological surgery demonstrated low postoperative mortality but substantial morbidity. Further research is needed to evaluate risk-mitigating strategies.

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慢性肾脏替代疗法对肾衰竭患者的妇科手术：发病率和死亡率结果的两国数据关联研究。

目的：评价妇科手术后慢性肾替代治疗肾衰竭患者的术后疗效。方法：这项两国数据链接研究通过澳大利亚和新西兰透析和移植登记处确定了2000年至2015年间接受重大妇科手术的肾衰竭患者。主要终点为术后死亡率。次要结局包括感染、医疗和伤口并发症、输血需求、重症监护病房（ICU）入院、再入院、住院时间和透析/移植特异性结局。采用单变量和多变量logistic及负二项回归模型。结果：403例患者中，腹式子宫切除术占30.5%，阴道子宫切除术占19.1%，卵巢手术占50.4%。30天死亡率和发病率分别为1.2%（95%可信区间[CI]: 0.5 ~ 3.0）和30.8% （95% CI: 26.3 ~ 35.6）。与腹式子宫切除术相比，阴道子宫切除术与输血减少（调整优势比[aOR]: 0.40, 95% CI: 0.16-0.98）、ICU入院（aOR: 0.28, 95% CI: 0.09-0.80）和住院时间缩短（IRR: 0.74, 95% CI: 0.55-0.99）相关。在所有肾脏替代疗法中，腹膜透析患者的术后死亡率最高（6.9%,95% CI: 1.2-24.2, P = 0.026）。该队列还需要更多的输血（aOR: 2.84, 95% CI: 1.12-7.21）和更长的住院时间（IRR: 1.58, 95% CI: 1.07-2.33）。肾移植受者住院较少（aOR: 0.22, 95% CI: 0.09-0.52），住院时间较短（IRR: 0.75, 95% CI: 0.58-0.96）。急诊入院和老年与较差的结果相关。结论：慢性肾脏替代治疗的妇科手术患者术后死亡率低，但发病率高。需要进一步的研究来评估风险缓解策略。

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来源期刊

International Journal of Gynecology & Obstetrics 医学-妇产科学

CiteScore

5.80

自引率

2.60%

发文量

493

审稿时长

3-6 weeks

期刊介绍： The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.