Presentation Details
| Perioperative Outcomes of Non‑Cardiac Surgery in Solid Organ Transplant Recipients Emre/C Ozcekirdek, Abigail Thorgerson, Khoua/N Thao, Dawson Aprill, Sneha Nagavally, Slawski Barbara. Medical College of Wisconsin, Milwaukee, WI, USA |
Abstract
BACKGROUND: Solid organ transplant recipients (SOTRs) frequently undergo non‑cardiac surgery (NCS) and may face elevated perioperative risk of complications from comorbidity burden and immunosuppression. There is little literature describing the risk of perioperative complications in SOTRs, with most in renal transplant patients.
METHODS: This is a retrospective study of patients >18 years old with previous lung, liver, renal, and pancreas transplants undergoing major noncardiac surgeries at a single academic medical center from 2013–2023. Patients with American Society of Anesthesiologists (ASA) scores of 5 and 6, cardiac transplant patients and anesthesia‑only procedures were excluded. One to four matching on age, sex, race, BMI, tobacco use, immunosuppressant use was used to identify controls. Outcomes included in‑hospital mortality; hospital/ICU length of stay (LOS); 72‑h and 30‑d readmissions; complications (cardiovascular, pulmonary, infectious, renal, hematologic, gastrointestinal, endocrine). Data was pulled from the electronic medical record database. Chi-square/ Fisher’s exact tests and 2-sample t-tests were run. R v 4.3.1 was used and an alpha level of 0.05 was chosen.
RESULTS: Of 7,140 matched patients, 1,428 were SOTRs (kidney 69.9%, liver 22.4%, lung 4.1%, pancreas 3.6%). SOTRs had longer hospital LOS and higher percentages of inpatient mortality, 72-h and 30-d readmissions. Any complication was more frequent among SOTRs, notably cardiovascular renal infectious pulmonary and hematologic; while gastrointestinal and endocrine were similar (table 1). Among liver transplant recipients (n=320), mortality, LOS, and 30‑d readmissions exceeded patients without transplants;72 h readmissions and ICU LOS were similar (table 2).
CONCLUSIONS: Prior solid organ transplant was associated with higher mortality, readmissions, complications, and longer hospitalization after NCS. These results were similar when evaluating patients with liver transplant only. Results support transplant‑aware optimization and targeted surveillance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: This is a retrospective study of patients >18 years old with previous lung, liver, renal, and pancreas transplants undergoing major noncardiac surgeries at a single academic medical center from 2013–2023. Patients with American Society of Anesthesiologists (ASA) scores of 5 and 6, cardiac transplant patients and anesthesia‑only procedures were excluded. One to four matching on age, sex, race, BMI, tobacco use, immunosuppressant use was used to identify controls. Outcomes included in‑hospital mortality; hospital/ICU length of stay (LOS); 72‑h and 30‑d readmissions; complications (cardiovascular, pulmonary, infectious, renal, hematologic, gastrointestinal, endocrine). Data was pulled from the electronic medical record database. Chi-square/ Fisher’s exact tests and 2-sample t-tests were run. R v 4.3.1 was used and an alpha level of 0.05 was chosen.
RESULTS: Of 7,140 matched patients, 1,428 were SOTRs (kidney 69.9%, liver 22.4%, lung 4.1%, pancreas 3.6%). SOTRs had longer hospital LOS and higher percentages of inpatient mortality, 72-h and 30-d readmissions. Any complication was more frequent among SOTRs, notably cardiovascular renal infectious pulmonary and hematologic; while gastrointestinal and endocrine were similar (table 1). Among liver transplant recipients (n=320), mortality, LOS, and 30‑d readmissions exceeded patients without transplants;72 h readmissions and ICU LOS were similar (table 2).
CONCLUSIONS: Prior solid organ transplant was associated with higher mortality, readmissions, complications, and longer hospitalization after NCS. These results were similar when evaluating patients with liver transplant only. Results support transplant‑aware optimization and targeted surveillance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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