• Csaba Gajdos, Mary T Hawn, Deidre Kile, Thomas N Robinson, and William G Henderson.
• Division of GI, Tumor, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA. csaba.gajdos@ucdenver.edu
• JAMA Surg. 2013 Feb 1;148(2):137-43.

HypothesisPatients on long-term dialysis undergoing major nonemergent general surgical procedures are thought to have high rates of postoperative complications and death.DesignRetrospective cohort study.SettingAcademic and private hospitals.PatientsThe American College of Surgeons National Surgical Quality Improvement Program database was used to select dialysis and nondialysis patients who had undergone nonemergent major general surgical procedures between 2005 and 2008. Multivariable logistic regression analysis was used to examine the effect of dialysis on 30-day surgical outcomes adjusted for age, race, sex, work relative value units, American Society of Anesthesiologists class, and recent operations (within the past 30 days).Main Outcome MeasuresPatient morbidity, mortality, and failure-to-rescue rates.ResultsDialysis patients undergoing major nonemergent general surgical procedures were significantly more likely to develop pneumonia, unplanned intubation, ventilator dependence, and need for a reoperation within 30 days from the index procedure. Dialysis patients also had a higher risk of vascular complications and postoperative death. Older dialysis patients (aged ≥ 65 years) had a significantly higher postoperative mortality rate compared with their younger counterparts. Dialysis patients were significantly more likely to die after any complication occurred, and mortality rates were especially high following stroke, myocardial infarction, and reintubation. Abnormalities in potentially modifiable preoperative variables (blood urea nitrogen level, albumin level, and hematocrit) did not increase the risk of postoperative complications or death in dialysis patients compared with nondialysis patients.ConclusionsDialysis patients undergoing nonemergent general surgery have significantly elevated risks of postoperative complications and death, particularly if they are aged 65 years or older.

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