Dharmenaan Palamuthusingam1,2,3, Arun Nadarajah4, David Wayne Johnson5,6,7, Elaine Marie Pascoe8, Carmel Marie Hawley5,6,8, Magid Fahim6,8. 1. Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland, 4131, Australia. Dharmenaan.palamuthusingam@health.qld.gov.au. 2. Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia. Dharmenaan.palamuthusingam@health.qld.gov.au. 3. School of Medicine, Griffith University, 68 University Dr, Meadowbrook, QLD, 4131, Australia. Dharmenaan.palamuthusingam@health.qld.gov.au. 4. Department of Surgery, Sunshine Coast University Hospital, Doherty St, Birtinya, Queensland, 4575, Australia. 5. Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia. 6. Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia. 7. Translational Research Institute, Brisbane, Australia. 8. Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia.
Abstract
BACKGROUND: Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS: Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS: Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION: Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
BACKGROUND: Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS: Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS: Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION: Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
Entities:
Keywords:
Chronic dialysis; End-stage kidney failure; Infection; Perioperative morbidity; Surgery
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