• Sirany Anne-Marie E AM 1 Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota 2 Department of Surgery, University of Minnesota, Minneapolis, Minn, Christopher J Chow, Hiroko Kunitake, Robert D Madoff, David A Rothenberger, and Mary R Kwaan.
• 1 Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota 2 Department of Surgery, University of Minnesota, Minneapolis, Minnesota 3 Department of Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
• Dis. Colon Rectum. 2016 Jul 1; 59 (7): 662-9.

BackgroundMore than 450,000 US patients with end-stage renal disease currently dialyze. The risk of morbidity and mortality for these patients after colorectal surgery has been incompletely described.ObjectiveWe analyzed the 30-day morbidity and mortality rates of chronic dialysis patients who underwent colorectal surgery.DesignThis was a retrospective analysis.SettingsHospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program were included.PatientsThe study included adult patients who underwent emergency or elective colon or rectal resection between 2009 and 2014.Main Outcome MeasuresBaseline characteristics were compared by dialysis status. The impact of chronic dialysis on 30-day mortality and serious postoperative morbidity was examined using multivariate logistic regression.ResultsWe identified 128,757 patients who underwent colorectal surgery in the American College of Surgeons National Surgical Quality Improvement Program database. Chronic dialysis patients accounted for 1% (n = 1285) and were more likely to be older (65.4 vs 63.2 years; p < 0.0001), black (27.2% vs 8.7%; p < 0.0001), preoperatively septic (22.1% vs 7.1%; p < 0.0001), require emergency surgery (52.0% vs 14.7%; p < 0.0001), have ischemic bowel (15.7% vs 1.6%; p < 0.0001), or have perforation/peritonitis (15.5% vs 4.2%; p < 0.0001). Chronic dialysis patients were also less likely to have a laparoscopic procedure (17.3% vs 45.0%; p < 0.0001). Chronic dialysis patients had higher unadjusted mortality (22.4% vs 3.3%; p < 0.0001), serious postoperative morbidity (47.9% vs 18.8%; p < 0.0001), and median length of stay (9 vs 6 days; p < 0.0001). In emergent cases (n = 19,375), multivariate logistic regression models demonstrated a higher risk of mortality for dialysis patients (OR = 1.73 (95% CI, 1.38-2.16)) but not for serious morbidity. Models for elective surgery demonstrated a similar effect on mortality (OR = 2.47 (95% CI, 1.75-3.50)) but also demonstrated a higher risk of serious morbidity (OR = 1.28 (95% CI, 1.04-1.56)).LimitationsThe postoperative 30-day window may underestimate the true incidence of serious morbidity and mortality.ConclusionsChronic dialysis patients undergoing elective or emergent colorectal procedures have a higher risk-adjusted mortality.

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