BACKGROUND: There is a paucity of quality data on the effects of chronic kidney disease in abdominal surgery. The aim of this study was to define the risk and outcome predictors of bowel resection in stage 5 chronic kidney disease using a large national clinical database. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried from years 2005-2010 for major bowel resection in dialysis-dependent patients. Patient demographics, preoperative risk factors, and intraoperative variables were evaluated. Primary endpoints were mortality and morbidity after 30 days. Predictors of outcome were assessed by multivariate regression. RESULTS: The study included 1,685 patients with chronic kidney disease undergoing bowel resection. Overall mortality and morbidity were 27.5 and 58.3 %, respectively. Acute presentation was the strongest predictor of mortality (OR 2.39, CI 1.54-3.72, p < 0.001). Other predictors of mortality included hypoalbuminemia (OR 2.12, CI 1.39-3.24, p < 0.001), pulmonary comorbidity (OR 2.25, CI 1.67-3.03, p < 0.001), and cardiac comorbidity (OR 1.54, CI 1.16-2.05, p = 0.003). CONCLUSION: This study demonstrates that bowel resection in patients with chronic kidney disease confers a high mortality risk. Preoperative optimization of comorbid conditions may reduce mortality after bowel resection in dialysis-dependent patients. In addition, laparoscopy was associated with a reduction in postoperative morbidity suggesting that it should be used preferentially.
BACKGROUND: There is a paucity of quality data on the effects of chronic kidney disease in abdominal surgery. The aim of this study was to define the risk and outcome predictors of bowel resection in stage 5 chronic kidney disease using a large national clinical database. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried from years 2005-2010 for major bowel resection in dialysis-dependent patients. Patient demographics, preoperative risk factors, and intraoperative variables were evaluated. Primary endpoints were mortality and morbidity after 30 days. Predictors of outcome were assessed by multivariate regression. RESULTS: The study included 1,685 patients with chronic kidney disease undergoing bowel resection. Overall mortality and morbidity were 27.5 and 58.3 %, respectively. Acute presentation was the strongest predictor of mortality (OR 2.39, CI 1.54-3.72, p < 0.001). Other predictors of mortality included hypoalbuminemia (OR 2.12, CI 1.39-3.24, p < 0.001), pulmonary comorbidity (OR 2.25, CI 1.67-3.03, p < 0.001), and cardiac comorbidity (OR 1.54, CI 1.16-2.05, p = 0.003). CONCLUSION: This study demonstrates that bowel resection in patients with chronic kidney disease confers a high mortality risk. Preoperative optimization of comorbid conditions may reduce mortality after bowel resection in dialysis-dependent patients. In addition, laparoscopy was associated with a reduction in postoperative morbidity suggesting that it should be used preferentially.
Authors: P Zerbib; D Koriche; S Truant; A F Bouras; G Vernier-Massouille; D Seguy; F R Pruvot; A Cortot; J F Colombel Journal: Aliment Pharmacol Ther Date: 2010-05-22 Impact factor: 8.171
Authors: Omar Faiz; Janindra Warusavitarne; Alex Bottle; Paris P Tekkis; Sue K Clark; Ara W Darzi; Paul Aylin Journal: J Am Coll Surg Date: 2010-04 Impact factor: 6.113
Authors: Fergal J Fleming; Todd D Francone; Michael J Kim; Douglas Gunzler; Susan Messing; John R T Monson Journal: Dis Colon Rectum Date: 2011-02 Impact factor: 4.585
Authors: W E Longo; K S Virgo; F E Johnson; C A Oprian; A M Vernava; T P Wade; M A Phelan; W G Henderson; J Daley; S F Khuri Journal: Dis Colon Rectum Date: 2000-01 Impact factor: 4.585
Authors: Amy J Sheer; Jennifer E Heckman; Eric B Schneider; Albert W Wu; Jodi B Segal; Richard Feinberg; Anne O Lidor Journal: Dis Colon Rectum Date: 2011-11 Impact factor: 4.585
Authors: Christopher R Schneider; William Cobb; Shivani Patel; David Cull; Cass Anna; Richard Roettger Journal: Am Surg Date: 2009-09 Impact factor: 0.688
Authors: J F Matthias Bechtel; Christian Detter; Theodor Fischlein; Thomas Krabatsch; Brigitte R Osswald; Friedrich-Christian Riess; Fridtjof Scholz; Markus Schönburg; Christof Stamm; Hans-Hinrich Sievers; Claus Bartels Journal: Ann Thorac Surg Date: 2008-01 Impact factor: 4.330
Authors: Anthony B Mozer; John R Pender; William H H Chapman; Megan E Sippey; Walter J Pories; Konstantinos Spaniolas Journal: Obes Surg Date: 2015-11 Impact factor: 4.129
Authors: Hayemin Lee; Cho Hyun Park; Seung Man Park; Wook Kim; Hyung Min Chin; Jin Jo Kim; Kyo Young Song; Sung Geun Kim; Kyong Hwa Jun; Jeong Goo Kim; Han Hong Lee; Junhyun Lee; Dong Jin Kim Journal: J Gastric Cancer Date: 2018-09-13 Impact factor: 3.720