Dialysis raises complication, mortality risk after general surgery

Long-term dialysis patients undergoing general surgical procedures have a significantly increased risk for postoperative complications and death within 30 days of surgery compared with their nondialysis counterparts, study findings show.

Length of hospital stay is longer among dialysis versus nondialysis patients, and dialysis patients aged over 65 years are more likely to die postoperatively than their younger peers.

The study results also indicate that while the most common postoperative adverse events in dialysis patients are pulmonary complications, the deadliest complications are vascular, in particular, myocardial infarction and stroke.

"The combined systemic effects of chronic renal disease create an altered physiological state for dialysis patients in the perioperative period," note Csaba Gajdos (University of Colorado Anschutz Medical Campus, Aurora, USA) and colleagues in the Archives of Surgery.

"This altered physiological state influences the way complications are handled by the body and decreases our ability to rescue the patient once a complication happens," they add.

Indeed, the failure-to-rescue rate for patients who developed any complication was significantly higher among dialysis patients compared with nondialysis patients, at 21.7% versus 6.4%.

The cohort included 165,600 major elective surgery patients with data stored in the American College of Surgeons National Surgical Quality Improvement Program, of whom 1506 were on dialysis within 2 weeks prior to surgery. Patients underwent a range of procedures for gastric, bowel, colorectal, spleen, and hernia conditions.

Dialysis patients were a significant 28% more likely to develop pneumonia, 82% more likely to undergo unplanned intubation, 94% more likely to be ventilator-dependent, and 94% more likely to return to the operating room within 30 days than their nondialysis counterparts.

Those on dialysis were also significantly more likely to develop any pulmonary complication, vascular outcome, or to die within 30 days of surgery, at odds ratios of 1.89, 1.69, and 2.57, respectively.

Gajdos and colleagues divided patients according to whether they were aged 65 years and older, or younger than 65 years, "because this is the point at which the average mean life expectancy for dialysis patients decreases to less than 5 years according to the US Renal Data Service."

The results showed that dialysis patients above this age cutoff were a significant 2.65 times more likely to die postoperatively than those aged under the cutoff.

"The significantly elevated risks of postoperative complications and death deserve an in-depth discussion with dialysis patients preoperatively," conclude the researchers.

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