Risk factors for maintenance hemodialysis patients undergoing elective and emergency abdominal surgery.
OBJECTIVE
To identify the risk factors for morbidity and mortality after elective and emergency abdominal surgeries in maintenance hemodialysis patients.


METHODS
We retrospectively evaluated the medical records of 63 hemodialysis patients who underwent elective (group 1) and 24 who underwent emergency (group 2) abdominal surgeries, and classified them according to the presence/absence of postoperative complications. The clinical, laboratory and procedure-related data were obtained and compared between the groups.


RESULTS
Group 2 had significantly higher morbidity and mortality rates than group 1 (58.3 and 16.6 % vs. 33.3 and 16.6 %, respectively, P < 0.05). The patients in group 1 with and without complications had significantly different blood urea nitrogen (BUN) levels of 52.3 vs. 41.6 mg/dL (P = 0.03). There were significant differences in the patients in group 2 in terms of the age (72.7 vs. 55.0 years old; P < 0.002), the length of the operation (141 vs. 107 min; P < 0.02), the total protein levels (6.2 vs. 6.7 g/dL; P < 0.03), albumin levels (3.2 vs. 3.7 g/dL; P < 0.04) and need for intra- or postoperative blood transfusions (71.4 vs. 10.0 %; P < 0.005).


CONCLUSIONS
The risk factors for a poor surgical outcome included high BUN levels in the elective surgery patients and hypoproteinemia, hypoalbuminemia, a longer operation and older age in patients undergoing emergency surgery. Perioperative blood transfusion was also associated with a high complication rate in the emergency surgery group.
Division of Gastrointestinal Surgery, Mitsui Memorial Hospital, 1 Kandaizumichou, Chiyoda-ku, Tokyo, Japan, abe.hayato@nihon-u.ac.jp.
Hayato
H
Abe
Ken-ichi
K
Mafune
D000005:Abdomen / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion; D001806:Blood Urea Nitrogen; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D006435:Renal Dialysis; D012307:Risk Factors; D013514:Surgical Procedures, Operative