Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures

Brakoniecki, Katrina; Tam, Sophia F.; Smith, Michael C.; Alfonso, Antonio E.; Sugiyama, Gainosuke

doi:10.1016/j.amjsurg.2016.03.009

Cited by 16 publications

(10 citation statements)

References 16 publications

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“…12 This is not surprising, given that end-stage renal disease has been shown to be a strong risk factor for readmission and postoperative complications after vascular and nonvascular operations. 5,7,[14][15][16][17] Traditionally, inpatient procedures that have begun to be performed as ambulatory operations, such as laparoscopic cholecystectomy, thyroidectomy, and sleeve gastrectomy, have relatively low readmission rates of between 0.9% and 8.5%. [18][19][20][21] In contrast, readmission rates of our outpatient vascular access operations are very high.…”

Section: Discussionmentioning

confidence: 99%

Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

Siracuse

Shah

Peacock

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

Siracuse

Shah

Peacock

et al. 2017

Journal of Vascular Surgery

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“…20 As well, other studies have evaluated the risk of mortality and ESRD utilizing the American College of Surgeons National Surgical Quality Improvement Program for common surgical procedures and reported that ESRD was associated with increased mortality odds ratio of 9, concluding that patients with ESRD face greater risks when entering the operating room. 21 A noticeable finding from this analysis was the increased stroke rates for patients with CKD who are not on dialysis. ESRD was not found to have a difference in stroke rate from normal renal function.…”

Section: Discussionmentioning

confidence: 83%

A contemporary evaluation of carotid endarterectomy outcomes in patients with chronic kidney disease in the United States

2017

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Objectives Chronic kidney disease (CKD) has been identified as a significant risk factor for poor post-surgical outcomes. This study was designed to provide a contemporary analysis of carotid endarterectomy (CEA) outcomes in patients with CKD, end-stage renal disease (ESRD), and normal renal function (NF). Methods The Nationwide Inpatient Sample data 2006-2012 was queried to select patients aging 40 years old and above who underwent CEA during two days after admission and had a diagnosis of ESRD on long-term hemodialysis, patients with non-dialysis-dependent CKD, or NF. Patients with acute renal failure were excluded. We subsequently compared procedure outcomes and hospital resource utilization in these patients. Results Totally 573,723 CEA procedures were estimated: 4801 (ESRD)' 32,988 (CKD)' and 535,934 (NF). Mean age was 71.0 years, 57.7% were males, and 73.7% were white. Overall hospital mortality was 0.20%: 0.69% (ESRD), 0.35% (CKD), and 0.19% (NF), p < 0.0005 between groups. The overall stroke rate was 1.6%: 1.8% (ESRD), 2.0% (CKD), and 1.6% (NF). Comparing NF to CKD there was a significant difference: p < 0.0001. For CKD patients, compared to NF patients, there was an increased risk in cardiac complications (odds ratio = 1.2; 95% CI 1.15-1.32), respiratory complications (odds ratio = 1.2; 95% CI 1.15-1.32), and stroke (odds ratio = 1.1; 95% CI 1.04-1.23). For ESRD patients compared to NF patients there was an increased risk in respiratory complications (odds ratio = 1.3; 95% CI 1.08-1.47) and sepsis (odds ratio = 4.4; 95% CI 3.23-5.94). Mean length of stay and cost were: 2.8 d and $13,903 (ESRD), 2.2 d and $12,057 (CKD), and 1.8 d and $10,130 (NF), all p < 0.0001. Conclusions Patients with ESRD undergoing CEA had an increased risk of respiratory and septic complications, but not a higher risk of stroke compared to patients with normal renal function. The greatest risks of postoperative stroke, respiratory, and cardiac complications were found in patients with CKD. A diagnosis of ESRD and CKD were both found to significantly increase hospital mortality, length of stay and cost. Where clinicians typically consider ESRD patients the highest risk for CEA, further consideration should be given to patients with CKD not yet on dialysis as they had the higher risk of cardiac complications and stroke compared to the others evaluated.

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“… 9 In common general surgeries (including colectomy, appendectomy, cholecystectomy, and ventral hernia repair), ESRD patients had an increased 30 day mortality rate, increased rates of infectious complications, and increased risk of returning to the operating room. 10 – 12 After a complication from a general surgical procedure, ESRD patients had a higher mortality rate than individuals with the same postoperative complications but who did not have ESRD. 11 In our study, we found increased rates of postoperative pneumonia, sepsis, dehiscence, bleeding requiring transfusion, and return to the operating room when compared to patients without ESRD on univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Ventral Hernia Repair Postoperative Complications in End Stage Renal Disease Patients

Gurien

Nofi

Coppa

et al. 2022

JSLS

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Background: The prevalence of patients with end stage renal disease (ESRD) requiring general surgical procedures is increasing. Our aim was to explore the effect of ESRD on patients undergoing elective laparoscopic ventral hernia repair. Methods: The American College of Surgeons National Surgical Quality Improvement Program (2010–2015) database was used to identify patients who underwent elective laparoscopic ventral hernia repair. Multivariable analysis was performed adjusting for risk variables including age, gender, race, comorbidity status, body mass index ≥ 35, and presence of ESRD. Results: A total of 8,789 patients undergoing elective laparoscopic ventral hernia repair were identified. Sixty-four patients (0.73%) had ESRD. ESRD was identified as an independent risk factor for postoperative pneumonia (odds ration [OR] 6.91, p = 0.00363), sepsis (OR 18.58, p = 0.000286), and length of stay (IRR 1.63, 95% confidence interval 1.19 – 2.27, p = 0.0036). Conclusions: ESRD patients undergoing elective laparoscopic ventral hernia repair had an increased risk of postoperative pneumonia, sepsis, and length of stay. Clinicians should be cognizant of these risks when performing elective operations on ESRD patients.

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Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures

Cited by 16 publications

References 16 publications

Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

A contemporary evaluation of carotid endarterectomy outcomes in patients with chronic kidney disease in the United States

Laparoscopic Ventral Hernia Repair Postoperative Complications in End Stage Renal Disease Patients

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