Evidence map›Paper›PMID 32011817›Full record

ArticleBJS open2020

Cardiovascular death and progression to end-stage renal disease after major surgery in elderly patients.

N Lysak, H Hashemighouchani, A Davoudi, N Pourafshar, T J Loftus, M Ruppert, P A Efron, P Rashidi, A Bihorac, T Ozrazgat-Baslanti

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJS open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.0field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Long-term risks of adverse kidney outcomes after acute kidney injury: a systematic review and meta-analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025
    Pooled it
  3. Article
  4. Article
  5. Observational
  6. Article
  7. Review
  8. Acute Kidney Injury and Progressive Diabetic Kidney Disease: An Epidemiological Perspective.International journal of nephrology and renovascular disease · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 1 country.

N LysakDepartment of Surgery, University of Florida, Gainesville, Florida, USA.
H HashemighouchaniDepartment of Medicine, University of Florida, Gainesville, Florida, USA.ORCID 0000-0002-1995-5072
A DavoudiDepartment of Biomedical Engineering, University of Florida, Gainesville, Florida, USA.
N PourafsharHealth Sciences Centre, University of Virginia, Charlottesville, Virginia, USA.
T J LoftusDepartment of Surgery, University of Florida, Gainesville, Florida, USA.
M RuppertDepartment of Medicine, University of Florida, Gainesville, Florida, USA.ORCID 0000-0001-9757-4454
P A EfronDepartment of Surgery, University of Florida, Gainesville, Florida, USA.
P RashidiDepartment of Biomedical Engineering, University of Florida, Gainesville, Florida, USA.
A BihoracDepartment of Medicine, University of Florida, Gainesville, Florida, USA.ORCID 0000-0002-5745-2863
T Ozrazgat-BaslantiDepartment of Medicine, University of Florida, Gainesville, Florida, USA.ORCID 0000-0002-1158-9928
University of Florida · USUniversity of Virginia · US

Funding

Using social networks to map and evaluate team science across CTSA hubsUL1TR001427 · NCATS · UNIVERSITY OF FLORIDA · PI MITCHELL, DUANE A. · 2015 to 2024
$37.2M
UF Clinical and Translational Science AwardUL1TR000064 · NCATS · UNIVERSITY OF FLORIDA · PI NELSON, DAVID R · 2012 to 2014
$12.2M
PICS: A New Horizon for Surgical Critical CareP50GM111152 · NIGMS · UNIVERSITY OF FLORIDA · PI MOORE, FREDERICK A · 2014 to 2018
$10.7M
Integrating data, algorithms and clinical reasoning for surgical risk assessmentR01GM110240 · NIGMS · UNIVERSITY OF FLORIDA · PI BIHORAC, AZRA, RASHIDI, PARISA · 2016 to 2025
$5.1M
Molecular Biology in Burns and TraumaT32GM008721 · NIGMS · UNIVERSITY OF FLORIDA · PI Philip A Efron · 1999 to 2026
$5.0M
NCATS NIH HHS UL1 TR000064NCATS NIH HHS UL1 TR001427NIGMS NIH HHS P50 GM111152NIGMS NIH HHS R01 GM110240NIGMS NIH HHS T32 GM008721
6 · The paper itself

Abstract

backgroundReliable estimates for risk of cardiovascular-specific mortality and progression to end-stage renal disease (ESRD) among elderly patients undergoing major surgery are not available. This study aimed to develop simple risk scores to predict these events.

methodsIn a single-centre cohort of elderly patients undergoing major surgery requiring hospital stay longer than 24 h, progression to ESRD and long-term cardiovascular-specific mortality were modelled using multivariable subdistribution hazard models, adjusting for co-morbidity, frailty and type of surgery.

resultsBefore surgery, 2·9 and 11·9 per cent of 16 655 patients had ESRD and chronic kidney disease (CKD) respectively. During the hospital stay, 46·9 per cent of patients developed acute kidney injury (AKI). Patients with kidney disease had a significantly higher risk of cardiovascular-specific (CV) mortality compared with patients without kidney disease (adjusted hazard ratio (HR) for CKD without AKI 1·60, 95 per cent c.i. 1·25 to 2·01; AKI without CKD 1·70, 1·52 to 1·87; AKI with CKD 2·80, 2·50 to 3·20; ESRD 5·21, 4·32 to 6·27), as well as increased progression to ESRD (AKI without CKD 5·40, 3·44 to 8·35; CKD without AKI 8·80, 4·60 to 17·00; AKI with CKD 31·60, 19·90 to 49·90). CV Death and ESRD Risk scores were developed to predict CV mortality and progression to ESRD. Calculated CV Death and ESRD Risk scores performed well with c-statistics: 0·77 (95 per cent c.i. 0·76 to 0·78) and 0·82 (0·78 to 0·86) respectively at 1 year.

conclusionKidney disease in elderly patients undergoing major surgery is associated with a high risk of CV mortality and progression to ESRD. Risk scores can augment the shared decision-making process of informed consent and identify patients requiring postoperative renal-protective strategies.

Indexed as

Acute Kidney InjuryAgedAged, 80 and overCardiovascular DiseasesCohort StudiesComorbidityDisease ProgressionFemaleFloridaHospitalizationHumansKaplan-Meier EstimateKidney Failure, ChronicMaleMultivariate AnalysisPostoperative Complications

Identifiers

PMID32011817
PMCPMC6996640
OpenAlexW2990155526

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.