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
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.
Available from: Ken-ichi Mafune
- "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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ABSTRACT: To identify the risk factors for morbidity and mortality after elective and emergency abdominal surgeries in maintenance hemodialysis patients.
We retrospectively evaluated the medical records of 63 hemodialysis patients who underwent elective (group 1) and 24 who underwent emergency (group 2) abdominal surgeries, and classified them according to the presence/absence of postoperative complications. The clinical, laboratory and procedure-related data were obtained and compared between the groups.
Group 2 had significantly higher morbidity and mortality rates than group 1 (58.3 and 16.6 % vs. 33.3 and 16.6 %, respectively, P < 0.05). The patients in group 1 with and without complications had significantly different blood urea nitrogen (BUN) levels of 52.3 vs. 41.6 mg/dL (P = 0.03). There were significant differences in the patients in group 2 in terms of the age (72.7 vs. 55.0 years old; P < 0.002), the length of the operation (141 vs. 107 min; P < 0.02), the total protein levels (6.2 vs. 6.7 g/dL; P < 0.03), albumin levels (3.2 vs. 3.7 g/dL; P < 0.04) and need for intra- or postoperative blood transfusions (71.4 vs. 10.0 %; P < 0.005).
The risk factors for a poor surgical outcome included high BUN levels in the elective surgery patients and hypoproteinemia, hypoalbuminemia, a longer operation and older age in patients undergoing emergency surgery. Perioperative blood transfusion was also associated with a high complication rate in the emergency surgery group.
Available from: Jay Jhaveri
- "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] "
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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.
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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.
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