Morbidity and Mortality Following Colorectal Surgery in Patients With End-Stage Renal Failure: A Population-Based Study

Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Diseases of the Colon & Rectum (Impact Factor: 3.75). 11/2010; 53(11):1508-16. DOI: 10.1007/DCR.0b013e3181e8fc8e
Source: PubMed


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.

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    • "Although the precise reason for the high incidence of pulmonary complications in patients receiving hemodialysis remains unknown, some studies have speculated that dialysis may induce hypoxemia because of carbon dioxide diffusion through the dialysate, subsequently leading to hypocapnia and reflex hypoventilation [9–11]. Although the percentage of patients who died from fatal cardiac or cerebrovascular complications was high, we suspect that these complications were likely caused by systemic vascular atherosclerosis in those receiving maintenance hemodialysis. "
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