Abstract
Background: End-stage renal disease (ESRD) patients are at a higher risk of perioperative complications. Existing perioperative risk assessment tools have been mainly validated in the general population. Despite the heightened risk of postoperative complications in patients with ESRD, there is a significant gap in research dedicated to studying preoperative risk calculators for this vulnerable population. Methods: We conducted a retrospective study of patients in the Acute Care Surgery National Surgical Quality Improvement Program database from 2008 to 2012. We compared the performance of the Revised Cardiac Risk Index (RCRI) and the American University of Beirut HAS2 (AUB-HAS2) in predicting cardiovascular events in patients with ESRD. Results: We analyzed 32,337 ESRD patients. The cohort had a mean age of 61.1 years, with 43.2% females. Key comorbidities included diabetes (47.4%), hypertension (85.1%), and history of myocardial infarction (MI) (4.2%). Mortality was 9.9%, with a composite outcome of death, MI, or stroke occurring in 11.3% of the patients. The RCRI and AUB-HAS2 scores were significantly associated with increased mortality and composite outcome, with mortality rates rising from 4.4% to 19.2% across RCRI scores and 1.8% to 23% across AUB-HAS2 scores. ROC curve analysis demonstrated the superior predictive performance of the AUB-HAS2 score over the RCRI for both mortality and composite outcome. Regression analysis confirmed the AUB-HAS2 score’s superior discrimination ability. Conclusion: Our findings suggest that the AUB-HAS2 score may be more effective than the RCRI in predicting cardiovascular events in patients with ESRD undergoing surgery.
Plain Language Summary
Patients with end-stage renal disease (ESRD) are at a significantly higher risk of perioperative complications, particularly cardiovascular events. Unfortunately, there is a paucity of research on this vulnerable population. We conducted a retrospective study of patients in the Acute Care Surgery National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2012. We compared the performance of the Revised Cardiac Risk Index (RCRI) and the American University of Beirut HAS2 (AUB-HAS2) in predicting cardiovascular events in patients with ESRD. We analyzed 32,337 patients with ESRD. Mortality during hospitalization was 9.9%, with a composite outcome of death, myocardial infarction, or stroke occurring in 11.3% of the patients. The RCRI and AUB-HAS2 scores were significantly associated with increased mortality and composite outcomes, with mortality rates rising from 4.4% to 19.2% across RCRI scores and 1.8% to 23% across AUB-HAS2 scores. ROC curve analysis demonstrated the superior predictive performance of the AUB-HAS2 score over the RCRI for both mortality (AUC 0.68 vs. 0.62, p < 0.001) and composite outcome (AUC 0.68 vs. 0.62, p < 0.001). Regression analysis confirmed the AUB-HAS2 score’s superior discrimination ability. Our findings suggest that the AUB-HAS2 score may be more effective than the RCRI in predicting cardiovascular events in patients with ESRD undergoing surgery.
