Surgical procedures before and after starting chronic hemodialysis in a predominantly male population with high prevalence of diabetes.
OBJECTIVE
The purposes of this study were to analyze changes in the frequency of different categories of surgical procedures after initiation of chronic hemodialysis (HD) and to identify the types of procedures associated with in-hospital postoperative mortality.


METHODS
This was a retrospective analysis of surgical procedures performed in an incident HD population of 392 patients followed in the dialysis unit of one hospital over 15 years. Among these patients, 384 were men and 258 had diabetes mellitus. At the start of HD, age of the patients was 66.3 ± 11.2 years and Charlson index 5.35 ± 2.41. Rates of procedures per patient year (n/[pt-yr]), reported as mean (95% Confidence Interval [CI]), were compared by nonparametric methods.


RESULTS
In the whole HD population, the overall rate of procedures increased in the HD period (pre-HD 0.125 [95% CI 0.101-0.149] n/[pt-yr]; HD 0.928 [95% CI 0.795-1.061] n/[pt-yr]; p<0.001). The increase, noted in patients with and without diabetes, reflected increases in the rates for both vascular access and non-vascular access procedures from the pre-HD to the HD period. Amputations and surgery for hip fractures accounted for the increase in the rates of procedures related to non-vascular access. Procedures associated with mortality in the HD period included amputations, hip repair and abdominal surgery for septic conditions.


CONCLUSIONS
Rates of surgical procedures for vascular access, amputations, and hip fractures ?increased after the start of HD. Amputations and hip fractures, both potentially preventable, are associated with mortality in HD patients.
Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, NM, USA.
Milagros
M
Martinez
Reuben
R
Last
Emmanuel I
EI
Agaba
Hussein
H
Kassam
Yijuan
Y
Sun
Karen S
KS
Servilla
Glen H
GH
Murata
Antonios H
AH
Tzamaloukas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D062666:Vascular Access Devices / Q000706:statistics & numerical data