Risk factors for morbidity and mortality following abdominal surgery in patients on maintenance hemodialysis.
OBJECTIVE
Major surgery in patients on maintenance hemodialysis is associated with an increased incidence of postoperative complications. We conducted the retrospective study to identify risk factors for morbidity and mortality after abdominal surgery in hemodialysis patients.


METHODS
Subjects were 28 consecutive patients on maintenance hemodialysis who underwent abdominal surgery for gastrointestinal disease. They were classified into two groups according to the presence (n = 11) or absence (n = 17) of postoperative complications. Clinical, laboratory, and operative data were obtained from medical records and compared between the two groups.


RESULTS
Overall morbidity and mortality rates were 39% (11/28) and 14% (4/28), respectively. The most frequent morbidity was wound complication (6/28). There were statistically significant differences between the patients with and without postoperative complications in the blood urea nitrogen concentration (41.6 vs. 27.5 mg/dL, P < 0.05), total protein level (5.8 vs. 6.9 g/dL, P < 0.01), and hematocrit level (25.7 us. 31.1%, P < 0.05). There were four hospital deaths. All four patients underwent emergency surgery for perforation of the gastrointestinal tract.


CONCLUSIONS
A poor surgical outcome after abdominal surgery in patients on maintenance hemodialysis was associated with a high concentration of blood urea nitrogen, hypoproteinemia, severe anemia, and emergency surgery. These factors should be considered in the perioperative management of chronic hemodialysis patients undergoing abdominal surgery.
Yasuda
Kazuhiro
K
Department of Surgery, Beppu Medical Center, Beppu, Japan. kyasuda@med.oita-u.ac.jp
Tahara
Kouichirou
K
Kume
Masazumi
M
Tsutsui
Shinichi
S
Higashi
Hidefumi
H
Kitano
Seigo
S
D000368:Aged; D001062:Appendectomy; D001660:Biliary Tract Diseases / Q000601:surgery; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D006400:Hematocrit; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011506:Proteins / Q000032:analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology
D011506:Proteins; D003404:Creatinine