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Outcomes after thoracic endovascular aortic repair in patients with chronic kidney disease in the Medicare population.
Brown, Chase R; Chen, Zehang; Khurshan, Fabliha; Kreibich, Maximillian; Bavaria, Joseph; Groeneveld, Peter; Desai, Nimesh.
Afiliação
  • Brown CR; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
  • Chen Z; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
  • Khurshan F; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
  • Kreibich M; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
  • Bavaria J; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
  • Groeneveld P; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Michael J. Crescenz VA Medical Center, Philadelphia, Pa.
  • Desai N; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa. Electronic address: Nimesh.Desai@uphs.upenn.edu.
J Thorac Cardiovasc Surg ; 159(2): 402-413, 2020 02.
Article em En | MEDLINE | ID: mdl-30955964
OBJECTIVE: Thoracic endovascular aortic repair has been increasingly performed in higher-risk patients with renal failure. The objective was to compare Medicare patients with preoperative chronic kidney disease with patients with normal renal function to determine differences in postoperative survival and complications. METHODS: From 2000 to 2014, 27,079 Medicare fee-for service patients underwent thoracic endovascular aortic repair. Patients were stratified by kidney function, and 23,375 patients (86%) had no chronic kidney disease, 2957 patients (11%) had chronic kidney disease stage I/IV, and 747 patients (3%) had end-stage renal disease or hemodialysis. Groups were then compared with determined differences in adjusted all-cause mortality and rates of postoperative complications. RESULTS: Overall survival was significantly worse among patients with chronic kidney disease and end-stage renal disease or hemodialysis compared with patients with no chronic kidney disease (1-year survival no chronic kidney disease: 78%; chronic kidney disease I/II: 77%; chronic kidney disease III: 67%; chronic kidney disease IV: 58%; and end-stage renal disease or hemodialysis: 48%, P < .001). Mortality was significantly increased among patients with chronic kidney disease III (hazard ratio [HR], 1.29; P < .001), chronic kidney disease IV (HR, 1.74; P < .001), and end-stage renal disease or hemodialysis (HR, 2.03; P < .001). No mortality difference was found between patients with no chronic kidney disease and patients with chronic kidney disease stage I/II. At 30 days after thoracic endovascular aortic repair, sepsis was increased for patients with chronic kidney disease stage III/IV (HR, 1.7; P < .001) and end-stage renal disease or hemodialysis (HR, 2.7; P < .001). CONCLUSIONS: In this elderly Medicare population undergoing thoracic endovascular aortic repair, patients with chronic kidney disease stage III, chronic kidney disease stage IV, or end-stage renal disease/hemodialysis had poor survival and increased morbidity compared with those with normal kidney function. These data may suggest that patients with chronic kidney disease stage III, chronic kidney disease stage IV, or end-stage renal disease/hemodialysis should be more cautiously evaluated for thoracic endovascular aortic repair, weighing the benefits of the procedure against the high expected mortality.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Aneurisma da Aorta Torácica / Insuficiência Renal Crônica / Procedimentos Endovasculares Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Aneurisma da Aorta Torácica / Insuficiência Renal Crônica / Procedimentos Endovasculares Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos