title: Recognizing risk: bowel resection in the chronic renal failure population.
abstract: BACKGROUND
  There is a paucity of quality data on the effects of chronic kidney disease in abdominal surgery. The aim of this study was to define the risk and outcome predictors of bowel resection in stage 5 chronic kidney disease using a large national clinical database.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried from years 2005-2010 for major bowel resection in dialysis-dependent patients. Patient demographics, preoperative risk factors, and intraoperative variables were evaluated. Primary endpoints were mortality and morbidity after 30 days. Predictors of outcome were assessed by multivariate regression.
  
  
  RESULTS
  The study included 1,685 patients with chronic kidney disease undergoing bowel resection. Overall mortality and morbidity were 27.5 and 58.3 %, respectively. Acute presentation was the strongest predictor of mortality (OR 2.39, CI 1.54-3.72, p < 0.001). Other predictors of mortality included hypoalbuminemia (OR 2.12, CI 1.39-3.24, p < 0.001), pulmonary comorbidity (OR 2.25, CI 1.67-3.03, p < 0.001), and cardiac comorbidity (OR 1.54, CI 1.16-2.05, p = 0.003).
  
  
  CONCLUSIONS
  This study demonstrates that bowel resection in patients with chronic kidney disease confers a high mortality risk. Preoperative optimization of comorbid conditions may reduce mortality after bowel resection in dialysis-dependent patients. In addition, laparoscopy was associated with a reduction in postoperative morbidity suggesting that it should be used preferentially.
authors.affiliation: Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA. james_iannuzzi@urmc.rochester.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.forename: Andrew-Paul
authors.initials: AP
authors.lastname: Deeb
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Rickles
authors.forename: Abhiram
authors.initials: A
authors.lastname: Sharma
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery*; D007420:Intestine, Large / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome