title: Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.
abstract: BACKGROUND
  End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined.
  
  
  METHODS
  Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes.
  
  
  RESULTS
  Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33) when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31) and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47) than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures.
  
  
  CONCLUSIONS
  Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.
authors.affiliation: Department of Anesthesiology, Shuang Ho Hospital, affiliated with Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Yih-Giun
authors.initials: YG
authors.lastname: Cherng
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
authors.forename: Tso-Hsiao
authors.initials: TH
authors.lastname: Chen
authors.forename: Duan
authors.initials: D
authors.lastname: Xiao
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D055815:Young Adult