title: The risk of major elective vascular surgical procedures in patients with end-stage renal disease.
abstract: OBJECTIVE
  To examine the postoperative complications and death rate of major elective vascular surgery procedures in patients with end-stage renal disease (ESRD).
  
  
  BACKGROUND
  Patients with ESRD undergoing elective major vascular surgical procedures are thought to have a high rate of postoperative complications and death.
  
  
  METHODS
  The American College of Surgeons-National Surgical Quality Improvement Program database was used to select ESRD and non-ESRD patients who had elective major vascular surgical procedures between 2004 and 2008. Multivariable logistic regression analysis was used to examine the impact of ESRD on 30-day surgical outcomes adjusted for age, race, sex, work relative value units, American Society of Anesthesiology class, and recent operations (within the past 30 days).
  
  
  RESULTS
  ESRD patients undergoing elective major vascular surgery were significantly more likely than non-ESRD patients to develop surgical site infection, unplanned intubation, ventilator dependence, combined pulmonary outcome, and a need for reoperation within 30 days of surgery. Importantly, ESRD patients undergoing elective major vascular surgery were also at higher risk for composite outcome and death within 30 days from surgery. ESRD patients above age 65 years undergoing elective major vascular surgery had far worse 30-day outcomes when compared with the younger ESRD cohort. Examining these data by their anatomic site (carotid, aortic, and peripheral) demonstrated elevated rates of postoperative complications and death in patients with ESRD undergoing open abdominal aortic aneurysm repair, carotid endarterectomies, and peripheral vascular operations compared with the non-ESRD cohort. Endovascular abdominal aortic aneurysm repair in ESRD patients had complications and death rates comparable with non-ESRD patients.
  
  
  CONCLUSIONS
  Patients with ESRD undergoing elective vascular surgery have a significantly elevated risk of postoperative complications and death after major vascular surgical operations--particularly in patients over age 65. These data, in combination with well-established reduced survival for the older ESRD population, call into question the utility of most carotid and aortic operations in these patients in the absence of symptoms or a rapidly enlarging aneurysm.
authors.affiliation: Section of GI, Tumor and Endocrine Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado at Denver, Aurora, CO 80045, USA. csaba.gajdos@ucdenver.edu
authors.forename: Csaba
authors.initials: C
authors.lastname: Gajdos
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: Deidre
authors.initials: D
authors.lastname: Kile
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Thomas
authors.initials: T
authors.lastname: Robinson
authors.forename: Martin
authors.initials: M
authors.lastname: McCarter
authors.forename: Mark
authors.initials: M
authors.lastname: Nehler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017558:Elective Surgical Procedures; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D006435:Renal Dialysis; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult