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Elective Surgery in Dialysis Patients: Comment on "Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis"

Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.3). 10/2012; DOI: 10.1001/2013.jamasurg.363
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    ABSTRACT: Patients on long-term dialysis undergoing major nonemergent general surgical procedures are thought to have high rates of postoperative complications and death. Retrospective cohort study. Academic and private hospitals. The American College of Surgeons National Surgical Quality Improvement Program database was used to select dialysis and nondialysis patients who had undergone nonemergent major general surgical procedures between 2005 and 2008. Multivariable logistic regression analysis was used to examine the effect of dialysis on 30-day surgical outcomes adjusted for age, race, sex, work relative value units, American Society of Anesthesiologists class, and recent operations (within the past 30 days). Patient morbidity, mortality, and failure-to-rescue rates. Dialysis patients undergoing major nonemergent general surgical procedures were significantly more likely to develop pneumonia, unplanned intubation, ventilator dependence, and need for a reoperation within 30 days from the index procedure. Dialysis patients also had a higher risk of vascular complications and postoperative death. Older dialysis patients (aged ≥ 65 years) had a significantly higher postoperative mortality rate compared with their younger counterparts. Dialysis patients were significantly more likely to die after any complication occurred, and mortality rates were especially high following stroke, myocardial infarction, and reintubation. Abnormalities in potentially modifiable preoperative variables (blood urea nitrogen level, albumin level, and hematocrit) did not increase the risk of postoperative complications or death in dialysis patients compared with nondialysis patients. Dialysis patients undergoing nonemergent general surgery have significantly elevated risks of postoperative complications and death, particularly if they are aged 65 years or older.
    JAMA SURGERY 02/2013; 148(2):137-43. DOI:10.1001/2013.jamasurg.347 · 4.30 Impact Factor
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    ABSTRACT: Aim of this study was to report our experience in elective and emergency surgery on chronic hemodialysis (CH) patients for end-stage renal disease (ESRD). All patients on CH for ESRD who underwent various surgical procedures in our unit within the past 9-year period (2001-2010) were included in this study. These patients were divided into two groups according to the type of surgery performed: elective or emergency. Demographic data, indications for surgery, primary causes of ESRD, surgical procedures, postoperative complications, and mortality rates were studied. Of 130 patients, 121 underwent elective surgery while 10 were addressed for emergency operation. In the elective surgery group, the most common diseases were secondary hyperparathyroidism, kidney diseases, cholelithiasis, and diabetic foot gangrene. Complications occurred in nine patients (morbidity rate, 7%) and only one patient died (mortality rate, 0.8%). In the emergency surgery group, the most common diseases were diabetic foot gangrene and obstructed sigmoid colon cancer. In this group, complications occurred in seven patients (total morbidity rate, 70%) and two patients died (mortality rate, 20%). Elective surgery in patients on CH for ESRD can be performed with acceptable surgical risks provided careful preoperative preparation, intraoperative, and postoperative precautions are taken.
    Renal Failure 08/2011; 33(7):672-6. DOI:10.3109/0886022X.2011.589940 · 0.78 Impact Factor
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    ABSTRACT: Three hundred twelve surgical procedures in patients with chronic renal failure have been characterized. There is a high incidence of operation in this expanding population. Multiple procedures for each patient were found in our 10 year study. Operative mortality was 1 percent and late mortality was about 10 percent per year. The survival curve predicted an 81 percent 2 year rate and a 60 percent 5 year survival rate. The high late mortality was likely related to the underlying disease process and the high proportion of complicating associated illnesses. The gross complication rate was high (64 percent), with the most frequent one being hyperkalemia. Other frequent complications were hemodynamic instability, infections, and fluid overload. A pattern of postoperative time to onset for the various complications was identified. Perioperative management requires aggressive, but appropriate metabolic, hematologic, and pharmaceutical intervention.
    The American Journal of Surgery 06/1986; 151(5):567-71. DOI:10.1016/0002-9610(86)90548-9 · 2.41 Impact Factor