Impact of Major Surgical Operations on Clinical Outcome in Dialysis Patients

Aim: We aimed to study the impact of major surgical procedures on clinical outcome in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or peritoneal dialysis (PD).

Methods: We retrospectively evaluated chart records of all patients on HD and PD who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical procedures were recorded.

Results: Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. Forty-seven patients (23%) had a major surgical operation. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study
population, 59 patients (29%) died during the study period. The mortality rate was higher in patients who experienced postoperative complications (P < .001). Kaplan–Meier analysis revealed that mean (95% CI) survival time in operated patients
was 43 months (37-49 months), while it was 49 months (46-52 months) in the others (P = .023). Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, P = .005), diabetes (RR 2.581, 95% CI 1.474-4.521, P = .001), pre-operative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, P < .0001) and undergoing a major surgical procedure (RR 1.868, 95% CI 1.068-3.268, P = .028) were independent predictors of mortality.

Conclusion: Our study shows that, in addition to age, diabetes, and inflammatory status, undergoing a major surgical procedure is an independent risk factor for mortality in dialysis patients. Proper management of perioperative complications may result in more favorable outcomes in these patients.

Cite this article as: Sadioğlu R, Şahin G, Aktar M, et al. Impact of major surgical operations on clinical outcome in dialysis patients. Turk J Nephrol. 2021; 30(2): 116-123.