Postoperative Outcomes after Gastrointestinal Surgery in Patients Receiving Chronic Kidney Replacement Therapy

Abstract

Objective: This study evaluated the postoperative mortality and morbidity outcomes following the different subtypes of gastrointestinal (GI) surgery over a 15-year period. Background: Patients receiving chronic kidney replacement therapy (KRT) experience higher rates of general surgery compared to other surgery types. Contemporary data on the types of surgeries and their outcomes are lacking. KRT was defined as patients requring chronic dialysis (haemodialysis or peritoneal dilaysis) or having a fucntioning kidney transplant long-term. Methods: All incident and prevalent patients aged greater than 18 years identified in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry as receiving chronic KRT were linked with jurisdictional hospital admission datasets between January 1 2000 until December 31 2015. Patients were categorised by their KRT modality (hemodialysis [HD], peritoneal dialysis [PD], home hemodialysis [HHD] and kidney transplant [KT]). GI surgeries were categorised: Upper gastrointestinal (UGI), bowel (small and large bowel), anorectal, hernia surgery, cholecystectomy and appendicectomy. The primary outcome was the rates of the different surgeries, estimated using Poisson models. Secondary outcomes were risks of 30-day/in-hospital postoperative mortality risk and non-fatal outcomes and were estimated using logistic regression. Independent predictors of 30-day-mortality were examined using comorbidity-adjusted Cox models. Results: Overall, 46,779 patients on chronic KRT were linked to jurisdictional hospital datasets, and 9,116 patients were identified as having undergone 14,540 GI surgeries with a combined follow-up of 76,593 years. Patients on PD had the highest rates of GI surgery (8 per 100-patient years), with hernia surgery being the most frequent. Patients on PD also had the highest risk of 30-day postoperative mortality following the different types of GI surgery, with the risk being more than 2-fold higher after emergency surgery compared to elective procedures. Infective postoperative complications were more common than cardiac complications. This study also observed a U-shaped association between body mass index (BMI) and mortality, with a nadir in the 30-35 kg/m2 group. Conclusions: Patients on chronic KRT have high rates of GI surgery and morbidity, particularly in those who receive PD, are older or are either underweight or moderately obese.