Background: Despite its potential clinical significance, the epidemiology and prognostic implications of postoperative new-onset proteinuria remain poorly characterized in major surgical populations. This national cohort study investigated the association between postoperative new-onset proteinuria and adverse outcomes in Chinese patients undergoing major surgery. Materials and methods: The study included participants aged ≥16 years who underwent major surgery between 2000 and 2022 from the China Renal Data System database. Postoperative dipstick proteinuria (measured within 30 days) was categorized as negative, trace, 1+, or ≥2+. The primary outcome was 30-day mortality. The secondary outcomes included 1-year mortality and a composite kidney outcome assessed via the postoperative estimated glomerular filtration rate. Multivariable Cox regression models were used to analyze the associations between postoperative new-onset proteinuria and outcomes, adjusted for pertinent covariates. Results: Postoperative new-onset proteinuria (dipstick: ≥ trace) was identified in 25.3% (12 829/50 728) of participants. The 30-day mortality rate was significantly higher in participants with postoperative new-onset proteinuria (6.5%, 829/12 829) than in those without (1.7%, 660/37 899). Multivariable-adjusted analyses demonstrated significant associations between postoperative new-onset proteinuria and adverse outcomes, with ≥2+ proteinuria showing the highest risks for 30-day mortality [adjusted hazard ratio (aHR) 2.14, 95% CI 1.56–2.92], 1–year mortality (aHR 1.65, 1.37–1.98), and kidney function decline (aHR 2.21, 1.65–2.94) in fully adjusted models (all P < 0.001). Subgroup analyses revealed that treatment with renin–angiotensin system inhibitors or statins significantly attenuated the proteinuria–mortality associations (both P for interaction < 0.001). Compared with participants without postoperative new-onset proteinuria, those with persistent proteinuria after major surgery exhibited a higher 1-year mortality risk (aHR 1.8, 95% CI 1.35–2.41). Conclusions: In this large national cohort, postoperative new-onset proteinuria affected one-quarter of patients undergoing major surgery and independently predicted higher mortality and a decline in kidney function. These findings underscore the importance of routine postoperative urinary screening among patients undergoing major surgery. Further research is needed to determine whether targeted management of proteinuria could improve patient outcomes.
Porcine and bovine bioprosthetic valves (porBHV and boBHV) are commonly used in surgical valve replacement, yet their durability across implant positions remains uncertain. This systematic review and meta-analysis compared survival, structural valve degeneration (SVD), and reoperation between porBHV and boBHV, stratified by implant position. We searched Medline, Embase, and Web of Science for cohort studies reporting odds ratios (ORs) with 95% confidence intervals (CIs) for mortality, SVD, and reoperation. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random-effects meta-analysis was used to pool ORs for clinical outcomes. Included bioprosthetic heart valves (BHVs) were classified into Generation 0, 1, or 2 according to anti-calcification treatment. Thirty-one studies (1988–2023) involving 65 783 patients (porBHV: 24 312; boBHV: 36 546) were included. In mitral valve replacement (MVR), porBHV was associated with lower mortality (OR 1.43, 95% CI 1.05–1.95, P = 0.02). Among Generation 2 valves in the mitral position, porBHV also showed lower rates of SVD than boBHV (OR 2.00, 95% CI 1.11–3.58; P = 0.02). In aortic valve replacement (AVR), porBHV showed higher SVD (OR 0.55, 95% CI: 0.35–0.87, P = 0.01) and reoperation rates (OR 0.69, 95% CI 0.50–0.95, P = 0.02). No significant differences were found in the pulmonary or unspecified positions. porBHV may be preferred in MVR because of better survival. boBHV showed lower SVD and reoperation rates in AVR overall; this apparent advantage may reflect differences in valve generation rather than intrinsic tissue superiority. Prosthesis selection should consider both implant position and valve generation.
Background: While glycemic control is a recognized determinant of surgical outcomes, its role in plastic surgery remains underexplored. This study investigates the prevalence of dysglycemia and its association with complications after procedures conducted by plastic surgeons using a national dataset. Methods: This multi-institutional retrospective cohort study analyzed 14,629 procedures conducted by plastic surgeons from the 2021 to 2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified into six groups based on diabetes diagnosis and hemoglobin A1c (HbA 1c ) levels. Multivariable logistic regression assessed associations between glycemic status and postoperative complications, controlling for comorbidities, demographics, and surgical factors. Subgroup analyses examined unadjusted procedure-specific risks across the ten most common surgeries. Results: About 7% of patients without a recorded diabetes diagnosis met laboratory thresholds for diabetes, highlighting a hidden burden of unrecognized metabolic dysfunction. Diagnosed diabetes was independently associated with higher odds of complications. Notably, even patients with normoglycemic HbA 1c (<5.7%) and a diabetes diagnosis showed elevated risks of any (aOR 1.4, P = 0.02) and medical complications (aOR 2.6, P < 0.001). Undiagnosed dysglycemia, however, was not linked to increased risk after adjustment. Complication rates varied by procedure type, with free flap reconstruction and mastopexy demonstrating a strong association between poor glycemic control and adverse outcomes. Conclusion: Dysglycemia is highly prevalent and significantly associated with adverse postoperative outcomes in plastic surgery. Even patients with “optimal” HbA 1c levels experienced elevated risks, suggesting that current HbA 1c thresholds may underestimate true perioperative vulnerability. Investigations into the utility of preoperative HbA 1c screening and treatment should be considered.
