title: Is it time to rethink our management of dialysis patients undergoing elective ventral hernia repair? Analysis of the ACS NSQIP database.
abstract: OBJECTIVE
  The number of patients on chronic dialysis is steadily increasing each year. There is little data that describes the outcomes in dialysis patients following elective ventral hernia repair, one of the most common general surgery procedures. Our objective was to compare the mortality and morbidity rates in dialysis versus nondialysis patients following elective ventral hernia repair.
  
  
  METHODS
  We analysed the ACS NSQIP database to identify patients that underwent elective ventral hernia repair from 2005 to 2010. Univariate analysis and multivariate logistic regression was performed on all patients included. The main outcome variables were mortality and morbidity, length of hospital stay, and return to the operating room.
  
  
  RESULTS
  Following elective ventral hernia repair, dialysis patients were more likely to die within 30 days or experience at least one morbidity. Dialysis patients were more likely to experience an infectious, pulmonary or vascular complication. Patients on dialysis also had a 2-fold greater risk of returning to the operating room within 30 days and stayed in the hospital an average of 1.3 days longer than nondialysis patients. Similar results were found after adjustment for demographics and comorbidities using multivariable logistic regression.
  
  
  CONCLUSIONS
  This is one of the largest studies demonstrating the outcomes of a specific general surgery procedure in dialysis patients. Chronic dialysis prior to elective ventral hernia repair is associated with an increased risk of 30-day mortality, morbidity, and return to the operating room. Dialysis patients are susceptible to infectious, pulmonary, and vascular post-operative complications.
authors.affiliation: SUNY Downstate College of Medicine, Brooklyn, NY, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: Tam
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, 11203, NY, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Au
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, 11203, NY, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Chung
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, 11203, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Duncan
authors.affiliation: SUNY Downstate College of Medicine, Brooklyn, NY, USA.|Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, 11203, NY, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Alfonso
authors.affiliation: SUNY Downstate College of Medicine, Brooklyn, NY, USA. gainosuke.sugiyama@downstate.edu.|Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, 11203, NY, USA. gainosuke.sugiyama@downstate.edu.
authors.forename: G
authors.initials: G
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: ACS NSQIP; Dialysis; Elective abdominal surgery; End-stage renal disease; Hemodialysis; Ventral hernia repair