Surgical mortality and morbidity in patients with end-stage renal disease
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:134A 1997
Patients with ESRD have a higher surgical risk than healthy patients. Data on 87,078 patients undergoing non-cardiac surgery between 1991 and 1993 (National VA Surgical Risk Study) were analyzed, of whom 854 (1%) had ESRD. African-American race, diabetes, and hypoalbuminemia were more common in ESRD. 30-day mortality was 18% in ESRD vs. 3% in non-ESRD patients (odds ratio 7.1) and hospital stay about twice as long (23 vs. 12 d). ESRD patients also had a 2-7 fold increased in severe post-operative complications. Adjustment for differences in serum albumin decreased the odds ratio for ESRD from 7.1 to 2.5. In conclusion, ESRD is associated with a 7-fold increase in operative mortality.
Comment: Much of the increase in surgical mortality can be explained by hypoalbuminemia which is a reflection of nutritional status (or covert inflammation). Whether the higher surgical risk in ESRD can be decreased by improvement in overall health and nutritional status prior to surgery needs evaluation. (David J. Leehey, M.D., Loyola University at Chicago)
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ASN 30th Annual Meeting, San Antonio
CRF: Problem Areas : Surgery in ESRD
CRF: Problem Areas : Outcomes (Morbidity, Mortality)