Wan-Hsiang Hu1,2, Luis Carlos Cajas-Monson1, Samuel Eisenstein1, Lisa Parry1, Sonia Ramamoorthy3,4. 1. Department of Surgery and Moores Cancer Center, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. 2. Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 3. 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. 4. 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.
Abstract
PURPOSE: 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.
PURPOSE: Dialysis is an important factor in predicting the risk associated with cardiovascular and general abdominal surgery. The association between cancerpatients 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 cancerpatients, 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: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Charles M Vollmer; Russell S Lewis; Bruce L Hall; John D Allendorf; Joal D Beane; Stephen W Behrman; Mark P Callery; John D Christein; Jeffrey A Drebin; Irene Epelboym; Jin He; Henry A Pitt; Emily Winslow; Christopher Wolfgang; Steven M Strasberg Journal: Ann Surg Date: 2015-03 Impact factor: 12.969
Authors: Vinod H Thourani; Eric L Sarin; Patrick D Kilgo; Omar M Lattouf; John D Puskas; Edward P Chen; Robert A Guyton Journal: J Thorac Cardiovasc Surg Date: 2011-08-25 Impact factor: 5.209
Authors: P Maisonneuve; L Agodoa; R Gellert; J H Stewart; G Buccianti; A B Lowenfels; R A Wolfe; E Jones; A P Disney; D Briggs; M McCredie; P Boyle Journal: Lancet Date: 1999-07-10 Impact factor: 79.321
Authors: J Y Liu; N J Birkmeyer; J H Sanders; J R Morton; H F Henriques; S J Lahey; R W Dow; C Maloney; A W DiScipio; R Clough; B J Leavitt; G T O'Connor Journal: Circulation Date: 2000-12-12 Impact factor: 29.690
Authors: Pierre J Guillou; Philip Quirke; Helen Thorpe; Joanne Walker; David G Jayne; Adrian M H Smith; Richard M Heath; Julia M Brown Journal: Lancet Date: 2005 May 14-20 Impact factor: 79.321
Authors: Peter J Hewett; Randall A Allardyce; Philip F Bagshaw; Christopher M Frampton; Francis A Frizelle; Nicholas A Rieger; J Shona Smith; Michael J Solomon; Jacqueline H Stephens; Andrew R L Stevenson Journal: Ann Surg Date: 2008-11 Impact factor: 12.969
Authors: Dharmenaan Palamuthusingam; Arun Nadarajah; Elaine M Pascoe; Jonathan Craig; David W Johnson; Carmel M Hawley; Magid Fahim Journal: PLoS One Date: 2020-06-26 Impact factor: 3.240
Authors: Christopher G Smith; Daniel L Davenport; Justin Gorski; Anthony McDowell; Brian T Burgess; Tricia I Fredericks; Lauren A Baldwin; Rachel W Miller; Christopher P DeSimone; Charles S Dietrich; Holly H Gallion; Edward J Pavlik; John R van Nagell; Frederick R Ueland Journal: Healthcare (Basel) Date: 2019-07-03