Elective and Emergency Surgery in Chronic Hemodialysis Patients

Abstract

Purpose: 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). Methods: All patients on CH for ESRD who underwent various surgical procedures in our unit within the past 9-year period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(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. Results: 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%). Conclusions: 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.

Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis

“…The postoperative mortality rate reported in small single-institution series of 1% to 6% 5,6,8 is in sharp contrast with findings from larger database studies such as that by Drolet at al 15 (10.3%) and our study (12.7%). Some of the small single-institution series reported about a 1% postoperative death rate for dialysis patients, 5,8 which is lower than the death rate for nondialysis patients in our study (1.5%). A likely explanation for this discrepancy is that less complex surgical procedures are reported in the single-institution series.…”

“…Despite reasonable outcomes from small single-center studies arguing for the relative safety of operating on dialysis patients, 5,8 larger population-based studies had significantly different findings. 15 Patients on long-term dialysis were found to have an increased risk of postoperative adverse events, longer length of stay, and higher rate of death following colorectal surgery.…”

“…[5][6][7][8][9] While complication and mortality rates of dialysis patients have been a subject of several articles in cardiac surgery, 10,11 there is a relative paucity of data on the complication and mortality rates of dialysis patients undergoing general surgery. As a result, the optimal perioperative medical and surgical management of these patients is poorly understood.…”

Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery

“…8,9 Patients on HD are at increased risk of postoperative complications because of the presence of metabolic and coagulopathic disorders and significant medical comorbidities, which can lead to renal failure. 13,14 In this study, 25 patients (69.4%) had comorbidities. Hypertension was the most common comorbidity, followed by diabetes mellitus.…”

End-stage renal disease increases the risk of mortality after appendectomy

“…Previous studies on this topic are limited by small sample size, single-institution patient populations, and restriction to elective procedures. [2][3][4][5] Appendectomy is a common cause of hospitalization and emergency surgery among adult patients. Typically, patients in need of emergency surgery do not have sufficient time for preoperative medical optimization by surgical and anesthesia teams.…”