People with kidney failure have a high frequency of major surgery compared to people with normal kidney function, though the risk of major perioperative events on a population-based level is unknown. We aimed to estimate the proportion of people with kidney failure that had an acute myocardial infarction (AMI) or died within 30 days of major surgery, stratified by the surgery type. We used administrative health and laboratory data from Alberta, Canada from April 2005 to February 2017. We included people with kidney failure (receipt of chronic dialysis or two outpatient eGFR measures <15 mL/min/1.73m2) that were adults (³18 years) admitted to hospital for a surgical procedure (this was the definition of major surgery that was used). We categorized surgery type using procedure codes from hospitalization data, and estimated the proportion of patients with AMI or death within 30 days of surgery, using postestimation commands following logistic regression. We also examined demographics, comorbidities, preoperative laboratory measures, procedure urgency, and kidney disease specific variables. Overall, 3,398 people with kidney failure had a major surgical procedure during the study period. Most surgeries were performed in people receiving chronic hemodialysis (n=1,905; 56.0%), followed by non-dialysis (n=903; 26.6%) and peritoneal dialysis (n=590; 17.4%). Over half of the procedures were urgent (56.9%), and performed mostly in males (61.0%) with a median age of 61.5 years (IQR 50.0, 72.7). Within 30 days of surgery, 198 people (5.8%) had an AMI or died. Kidney transplantation had the lowest probability of the outcome (0.7%), while the highest probability was found for neurosurgery (33.3%), anorectal surgery (11.8%), and retroperitoneal surgery (10.0%) (Figure 1). The risk of AMI or death within 30 days of major non-cardiac surgery in people with kidney failure varies significantly based on the type of surgery performed. These findings have implications for the direction of future perioperative research in this population.