Morbidity and Mortality Following Colorectal Surgery in Patients With End-Stage Renal Failure: A Population-Based Study
ABSTRACT The risk of abdominal surgery in patients with end-stage renal failure is poorly defined. Our objective was to describe outcomes of colorectal surgery in dialysis patients from a population-based perspective.
We analyzed the 1993 to 2007 Nationwide Inpatient Sample to identify patients hospitalized for colorectal surgery. The effect of renal failure on mortality, complications, length of stay, and charges was evaluated using logistic regression models.
Between 1993 and 2007, there were 755,343 admissions for colorectal surgery in the Nationwide Inpatient Sample database; 5806 patients (0.77%) were receiving dialysis treatment (87.4% hemodialysis, 4.9% peritoneal dialysis, 7.7% method not specified). Patients undergoing dialysis had an increased risk of mortality (22.1% vs 2.8%; adjusted OR 4.83; 95% CI 4.58-5.31) and complications (52.1% vs 34.0%; adjusted OR 2.04; 95% CI 1.90-2.17). Dialysis patients undergoing nonelective procedures had a 2-fold higher mortality rate than patients having had elective surgery (25.5% vs 10.3%; adjusted OR 2.01; 95% CI 1.65-2.43). In nonelective surgery, independent predictors of mortality included procedures with an end-stoma (adjusted OR 1.86; 95% CI 1.58-2.18), age over 60 (adjusted OR 1.73; 95% CI 1.43-2.08), total colectomy (adjusted OR 1.68; 95% CI 1.27-2.22), vascular insufficiency as surgical indication (adjusted OR 1.58; 95% CI 1.32-1.90), nonprivate insurance coverage (adjusted OR 1.38; 95% CI 1.07-1.77) and malnutrition (adjusted OR 1.26; 95% CI 1.01-1.59).
Patients receiving dialysis treatment have an increased risk of morbidity and mortality following colorectal surgery. Elective procedures are associated with a 10% rate of mortality in this population. Dialysis patients are especially susceptible to infectious and pulmonary complications after colorectal resection. Additional studies are necessary to refine risk stratification in this high-risk patient population.
- SourceAvailable from: Jay Jhaveri
[Show abstract] [Hide abstract]
- "Insurance Several reports have demonstrated a link between private insurance status and improved short-term adverse outcomes over a wide variety of surgical procedures and medical admissions, even after multivariable adjustment [Drolet et al. 2010; Hasan et al. 2010; McClelland et al. 2011] "
ABSTRACT: Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority.Therapeutic Advances in Urology 04/2012; 4(2):61-75. DOI:10.1177/1756287211433187
- [Show abstract] [Hide abstract]
ABSTRACT: We are developing the energy-selective neutron radiography and tomography technique by using the pulsed neutron source and the time-of-flight (TOF) spectroscopy. Neutron resonance absorption spectroscopy with computer tomography, N-RAS/CT, can non-destructively give the tomographic image indicating material information such as nuclide, density and temperature inside the object. The primary N-RAS/CT was performed by detecting prompt γ-rays emitted from nuclei absorbing neutrons as a function of neutron TOF. In this case, position dependent data need to be obtained by scanning the object with a moving slit. On the other hand, in this paper, we propose a new N-RAS/CT method using neutron transmission spectroscopy combined with 2-dimensional position sensitive neutron detector (2d-PSND), which is applicable to TOF measurement. The greatest feature of this method is shorter measurement time than the previous one because 2d-PSND can obtain spatial information at once. For this reason, we carried out the new N-RAS/CT experiment to examine its feasibility at the pulsed neutron facility based on the small accelerator.Nuclear Instruments and Methods in Physics Research Section A Accelerators Spectrometers Detectors and Associated Equipment 06/2009; DOI:10.1016/j.nima.2009.01.124 · 1.32 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Privately insured patients may have favorable health outcomes when compared to those covered by federally funded initiatives. This study explored the effect of insurance status on five short-term outcomes after partial nephrectomy (PN). Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed between 1998 and 2007. We tested the rates of in-hospital mortality, blood transfusions, prolonged length of stay, as well as intraoperative and postoperative complications, stratified according to insurance status. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Overall, 8,513 PNs were identified. Of those, most patients were privately insured (53.5%), followed by Medicare (37.5%), uninsured (4.6%) and Medicaid (4.4%). Medicare and Medicaid patients had higher rates of transfusions (P < 0.001) and overall postoperative complications (P < 0.001). In multivariable analyses, when compared to privately insured patients, Medicaid patients had higher rates of transfusions (OR = 1.91, P < 0.001) and prolonged length of stay (OR = 1.49, P < 0.001). Medicare patients had higher rates of overall postoperative complications (OR = 1.24, P = 0.015) and length of stay beyond the median (OR = 1.4, P < 0.001). Patients with private insurance undergoing PN have better short-term outcomes, when compared to their publicly insured counterparts.International Urology and Nephrology 09/2011; 44(2):343-51. DOI:10.1007/s11255-011-0056-1 · 1.29 Impact Factor