K. Brakoniecki1, S. Tam1, P. Chung2, A. Alfonso2, G. Sugiyama2 1SUNY Downstate College Of Medicine,Brooklyn, NY, USA 2SUNY Downstate Medical Center,Surgery,Brooklyn, NY, USA
Introduction:
Improvements in care of patients with end-stage renal disease (ESRD) have resulted in decreased mortality rates since 2001. A greater number of those on dialysis are living longer and undergo common general surgery procedures. The few studies which have investigated surgical outcomes in patients with ESRD have shown rates of return to the operating room (OR) nearly 3 times of those not on dialysis. Subsequently returning to the OR is associated with postoperative mortality and morbidity. Our objective was to assess the morbidity and mortality of patients with ESRD undergoing the most common general surgery procedures, and determine the risk factors for returning to the OR.
Methods:
Data was extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients that underwent appendectomy, cholecystectomy, ventral hernia repair, and colectomy from 2005-2010 were selected by CPT codes and then separated based on dialysis status. Matched cohorts based on age, gender and procedure type, were created randomly using SPSS. Multivariate logistic regression was used to analyze the effect of dialysis on mortality, morbidity, and returning to the OR. The dialysis group was further stratified into “return to OR” and “no return to OR”, and compared in terms of pre-operative and surgical profiles. Multivariate logistic regression analysis was performed to analyze the effect of returning to the OR on postoperative mortality and morbidity in dialysis patients.
Results:
A total of 195,585 patients underwent the described procedures, of which 1,163 dialysis patients were identified, and matched with non-dialysis patients. Dialysis was associated with a higher risk of returning to the OR, (odds ratio [OdR] 2.97 [1.99-4.46]), mortality (OdR 9.05 [4.09-20.00]), and morbidity (OdR 1.66 [1.29-2.13]). Of the dialysis patients, 94 (8%) returned to the OR, and return to the OR was associated with increased mortality (OdR 4.35 [2.11-8.99]) and morbidity (OdR 7.62 [4.68-12.41]). Those with post-operative infection complication were over 8 times (OdR 8.23 [4.92-13.75]) more likely to return to the OR.
Conclusion:
Using the ACS-NSQIP database we describe increased rates of return to the OR in dialysis patients, for the most common general surgery procedures. Furthermore, within this population, returning to the OR is associated with significantly increased morbidity and mortality. Surgeons should be aware of the risk of returning to the OR, and subsequently the high risk of mortality and morbidity in dialysis patients. Further study is needed to elucidate preventable risk factors to protect patients from this emerging public health issue.