title: Association of dialysis with adverse postoperative outcomes in colorectal cancer-an analysis of ACS-NSQIP.
abstract: OBJECTIVE
  Dialysis is an important factor in predicting the risk associated with cardiovascular and general abdominal surgery. The association between cancer patients and dialysis was also studied, and in particular, the effects of dialysis on the postoperative outcomes of colorectal cancer which has not been widely reported in the literature.
  
  
  METHODS
  This is a retrospective, multi-institutional study of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database, investigating preoperative dialysis status and its association with postoperative mortality and morbidity.
  
  
  RESULTS
  Among 42,403 colorectal cancer patients, 265 patients (0.6 %) were receiving dialysis. Patients undergoing dialysis had a higher risk of re-intubation (6.8 %, p < 0.001), on ventilator-support more than 48 h (7.2 %, p < 0.001), and sepsis (7.2 %, p < 0.05). Deep surgical site infection (adjusted odds ratio = 2.09), pneumonia (adjusted odds ratio = 1.86), and septic shock (adjusted odds ratio = 1.9) were significantly associated with dialysis status. The postoperative mortality rate of dialysis patients was 8.3 % (p < 0.001) and had significant association in a multivariate Cox proportional hazard model (hazard ratio = 1.63, p = 0.026). Total length of hospital stay (coefficient = 3.5, p < 0.001) and overall complication (coefficient = 0.134, p < 0.001) were prominent in the dialysis groups. The rate of laparoscopic surgery in dialysis and non-dialysis patients was 33 and 42 %, respectively (odds ratio = 0.693, p = 0.005).
  
  
  CONCLUSIONS
  In colorectal cancer, dialysis status significantly contributes to postoperative morbidity, length of total hospital stay, and mortality. In addition, the rates of preventable infection and pulmonary complications were shown to require more careful attention in the hospital setting, and particularly in dialysis patients. Preoperative dialysis patients are less likely than non-dialysis patients to undergo a minimally invasive approach.
authors.affiliation: Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA.|Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wan-Hsiang
authors.initials: WH
authors.lastname: Hu
authors.affiliation: Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Cajas-Monson
authors.affiliation: Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Eisenstein
authors.affiliation: Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Parry
authors.affiliation: Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. sramamoorthy@mail.ucsd.edu.|Department of Surgery and Moores Cancer Center, University of California, San Diego Health System, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA. sramamoorthy@mail.ucsd.edu.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Colorectal cancer; Dialysis; Postoperative morbidity; Postoperative mortality