title: Renal transplant status in patients undergoing colorectal surgery: is immunosuppression safer than kidney disease?
abstract: BACKGROUND
  It is unknown how colorectal surgical outcomes in recipients of renal transplants (TXP) compare to the outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
  
  
  METHODS
  Data from the Nationwide Inpatient Sample for 2004 to 2008 were reviewed. International Classification of Diseases (ICD-9) codes identified patients undergoing colorectal surgery who were stratified as having no kidney disease, CKD, ESRD, or TXP. The effects of renal status on mortality, length of hospital stay, and hospital costs were determined.
  
  
  RESULTS
  A total of 171,133 patients were identified; 162,986 had no kidney disease, 3,686 had CKD, 1,296 had ESRD, and 3,765 had had TXP. The odds of death after surgery were 43% more likely for patients with CKD, 82% more likely for TXP, and 240% more likely for those with ESRD. TXP resulted in an additional length of hospital stay of 3.4 days, compared to 3.2 days for those with ESRD, and 1.1 days for those with CKD (P < .0001). CKD added $4,223 in additional costs, TXP added $8,213, and ESRD added $12,821 (P < .0001). TXP demonstrated odds of mortality between those of CKD and ESRD for cardiovascular complications (OR 2.47). Pulmonary complications resulted in the highest odds of mortality for TXP (OR 6.3).
  
  
  CONCLUSIONS
  After TXP, patients undergoing colorectal surgery have mortality and costs between those of patients with CKD and ESRD, with pulmonary complications remaining high mortality events.
authors.affiliation: Department of Surgery, Pennsylvania State University, College of Medicine, Hershey Medical Center, Hershey, PA 17033, USA. dstewart@hmc.psu.edu
authors.forename: David B
authors.initials: DB
authors.lastname: Stewart
authors.forename: Christopher
authors.initials: C
authors.lastname: Hollenbeak
authors.forename: Melissa
authors.initials: M
authors.lastname: Boltz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007165:Immunosuppression Therapy; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications; D014481:United States / Q000453:epidemiology; D055815:Young Adult