Kidney Week

Abstract: FR-PO839

Postoperative Outcomes in Chronic Dialysis Patients: A Meta-Analysis of 37 Studies and 75,428 Patients

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Palamuthusingam, Dharmenaan, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Dharmenaan Palamuthusingam,

• Nadarajah, Arun, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Arun Nadarajah,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• Craig, Jonathan C., University of Sydney/Children's Hospital, Sydney, New South Wales, Australia

Jonathan C. Craig,

• Pascoe, Elaine M., The University of Queensland, Brisbane, Queensland, Australia

Elaine M. Pascoe,

• Hawley, Carmel M., Princess Alexandra Hospital, Brisbane, Queensland, Australia

Carmel M. Hawley,

• Fahim, Magid, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Magid Fahim,

Background

Chronic dialysis patients frequently undergo major surgery, but their absolute and relative risk of postoperative complications is unclear. The aim of this study was to estimate the risks of fatal and non-fatal postoperative outcomes in chronic dialysis patients undergoing non-transplant surgery.

Methods

Two authors performed a systematic review of observational studies indexed in Embase and MEDLINE till July 2017 that reported postoperative outcomes in chronic dialysis and non-dialysis patients undergoing major, non-transplant surgery. Summary level data on study characteristics, type of surgical procedure, patient demographics and comorbidity were extracted. The primary outcome was death(30-day or in-hospital mortality); secondary outcomes were myocardial infarction and sepsis. Random effects meta-analysis was performed to derive summary risk estimates and meta-regression was performed to explore heterogeneity.

Results

37 studies involving 75,428 chronic dialysis and 9,624,178 non-dialysis patients undergoing orthopedic, vascular, cardiothoracic, general and urological procedures were included. Summary, unadjusted risk estimates showed increased risks of postoperative mortality (7.2% vs. 0.2%, OR 5.61, 95%CI 4.5-7.0, I²90%), myocardial infarction (1.1% vs. 0.3%, OR 3.3, 95% CI 2.3-4.7, I²74%) and sepsis (6.3% vs. 0.6%, OR 3.6, 95% CI 2.4-5.3, I²96%) in dialysis patients compared to non-dialysis patients irrespective of discipline. Adjustment for age and comorbidity attenuated the risks of postoperative death (OR 3.1, 95% CI 2.9-3.3 I²90%), myocardial infarction (OR 1.8, 95% CI 1.3-2.3, I²0%) and sepsis (OR 2.6, 95% CI 2.3-2.9, I²70%). Weighted univariate metaregression showed a significant association between individual study reported mortality odds ratios and differences in age (slope 0.099, p<0.01), cardiac disease prevalence (slope 0.002, p<0.01) and diabetes prevalence (slope 0.49, p<0.01) between dialysis and non-dialysis patients.

Conclusion

Chronic dialysis patients have substantially increased risks of both fatal and non-fatal postoperative complications across all surgical disciplines. This heightened risk is attributable not only to their dialysis dependency, but also to their older age and higher comorbid illness burden.

Funding

• Government Support - Non-U.S.