Colorectal Surgery Outcomes in Chronic Dialysis Patients: An American College of Surgeons National Surgical Quality Improvement Program Study.
BACKGROUND
More than 450,000 US patients with end-stage renal disease currently dialyze. The risk of morbidity and mortality for these patients after colorectal surgery has been incompletely described.


OBJECTIVE
We analyzed the 30-day morbidity and mortality rates of chronic dialysis patients who underwent colorectal surgery.


METHODS
This was a retrospective analysis.


METHODS
Hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program were included.


METHODS
The study included adult patients who underwent emergency or elective colon or rectal resection between 2009 and 2014.


METHODS
Baseline characteristics were compared by dialysis status. The impact of chronic dialysis on 30-day mortality and serious postoperative morbidity was examined using multivariate logistic regression.


RESULTS
We identified 128,757 patients who underwent colorectal surgery in the American College of Surgeons National Surgical Quality Improvement Program database. Chronic dialysis patients accounted for 1% (n = 1285) and were more likely to be older (65.4 vs 63.2 years; p < 0.0001), black (27.2% vs 8.7%; p < 0.0001), preoperatively septic (22.1% vs 7.1%; p < 0.0001), require emergency surgery (52.0% vs 14.7%; p < 0.0001), have ischemic bowel (15.7% vs 1.6%; p < 0.0001), or have perforation/peritonitis (15.5% vs 4.2%; p < 0.0001). Chronic dialysis patients were also less likely to have a laparoscopic procedure (17.3% vs 45.0%; p < 0.0001). Chronic dialysis patients had higher unadjusted mortality (22.4% vs 3.3%; p < 0.0001), serious postoperative morbidity (47.9% vs 18.8%; p < 0.0001), and median length of stay (9 vs 6 days; p < 0.0001). In emergent cases (n = 19,375), multivariate logistic regression models demonstrated a higher risk of mortality for dialysis patients (OR = 1.73 (95% CI, 1.38-2.16)) but not for serious morbidity. Models for elective surgery demonstrated a similar effect on mortality (OR = 2.47 (95% CI, 1.75-3.50)) but also demonstrated a higher risk of serious morbidity (OR = 1.28 (95% CI, 1.04-1.56)).


CONCLUSIONS
The postoperative 30-day window may underestimate the true incidence of serious morbidity and mortality.


CONCLUSIONS
Chronic dialysis patients undergoing elective or emergent colorectal procedures have a higher risk-adjusted mortality.
1 Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota 2 Department of Surgery, University of Minnesota, Minneapolis, Minnesota 3 Department of Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Anne-Marie E
AM
Sirany
Christopher J
CJ
Chow
Hiroko
H
Kunitake
Robert D
RD
Madoff
David A
DA
Rothenberger
Mary R
MR
Kwaan
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000401:mortality; D003108:Colonic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D058996:Quality Improvement; D012002:Rectal Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors