Surgery in long-term dialysis patients. Experience with more than 300 cases.

Three hundred twelve surgical procedures in patients with chronic renal failure have been characterized. There is a high incidence of operation in this expanding population. Multiple procedures for each patient were found in our 10 year study. Operative mortality was 1 percent and late mortality was about 10 percent per year. The survival curve predicted an 81 percent 2 year rate and a 60 percent 5 year survival rate. The high late mortality was likely related to the underlying disease process and the high proportion of complicating associated illnesses. The gross complication rate was high (64 percent), with the most frequent one being hyperkalemia. Other frequent complications were hemodynamic instability, infections, and fluid overload. A pattern of postoperative time to onset for the various complications was identified. Perioperative management requires aggressive, but appropriate metabolic, hematologic, and pharmaceutical intervention.