Differences in Postoperative Disposition by Kidney Disease Severity: A Population-Based Cohort Study

People with advanced kidney disease undergo more non-cardiac operations compared to the general population, with a higher risk of perioperative cardiac events and death. However, little is known about the associations between severity of preoperative kidney dysfunction with postoperative length of hospitalization and discharge disposition; these were the focus of this study. Population-based retrospective cohort. Adults from Alberta, Canada undergoing inpatient major noncardiac surgery between April 2005 and February 2019. Categorical preoperative outpatient estimated glomerular filtration rate (eGFR) or kidney failure status. Length of stay (LOS), days alive at home after surgery within 30 and 90 days, and discharge disposition location. Associations were estimated with unadjusted and adjusted generalized estimating equation models. 927,560 inpatient surgeries in 666,770 people (55.9% female, median age 57.4 years) were identified. People receiving dialysis had the longest LOS (11 days [95% CI 6, 29), 2 times greater than that among people with normal kidney function (adjusted incidence rate ratio [IRR] 2.21 [95% CI 2.10, 2.32]). This group also had the fewest days alive at home within the first 30 days after surgery, with an IRR of 0.69 (95% CI 0.67, 0.70) compared to people with normal eGFR. The majority of people (82.8%) were discharged home without nursing support after surgery, though people receiving dialysis were discharged to a facility with 24-hour nursing care nearly 4 times more often. There were graded increases in risks of these outcomes with lower levels of kidney function. Many people did not have preoperative kidney function assessed, reflecting standard clinical practice in the general population. After major surgery, people with kidney disease spend more time recovering in hospital and have less independence from post-discharge nursing supports than otherwise similar patients who have normal or near normal kidney function. These differences were more pronounced for those with the most severe stages of kidney disease.