Risk factors for morbidity and mortality following abdominal surgery in patients on maintenance hemodialysis.

BACKGROUND/AIMS: Major surgery in patients on maintenance hemodialysis is associated with an increased incidence of postoperative complications. We conducted the retrospective study to identify risk factors for morbidity and mortality after abdominal surgery in hemodialysis patients.

METHODOLOGY

Subjects were 28 consecutive patients on maintenance hemodialysis who underwent abdominal surgery for gastrointestinal disease. They were classified into two groups according to the presence (n = 11) or absence (n = 17) of postoperative complications. Clinical, laboratory, and operative data were obtained from medical records and compared between the two groups.

RESULTS

Overall morbidity and mortality rates were 39% (11/28) and 14% (4/28), respectively. The most frequent morbidity was wound complication (6/28). There were statistically significant differences between the patients with and without postoperative complications in the blood urea nitrogen concentration (41.6 vs. 27.5 mg/dL, P < 0.05), total protein level (5.8 vs. 6.9 g/dL, P < 0.01), and hematocrit level (25.7 us. 31.1%, P < 0.05). There were four hospital deaths. All four patients underwent emergency surgery for perforation of the gastrointestinal tract.

CONCLUSIONS

A poor surgical outcome after abdominal surgery in patients on maintenance hemodialysis was associated with a high concentration of blood urea nitrogen, hypoproteinemia, severe anemia, and emergency surgery. These factors should be considered in the perioperative management of chronic hemodialysis patients undergoing abdominal surgery.