Surgical Procedures on Patients in End-stage Renal Failure

Lissoos, I; Goldberg, B; Blerk, P. J. P. Van; Meijers, A. M.

doi:10.1111/j.1464-410x.1973.tb12172.x

Cited by 23 publications

(7 citation statements)

References 14 publications

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“…Few, however, describe outcomes for ESRD patients who presented for general surgical procedures. [2][3][4][5][6][7][8][9][10] These series have included patients from multiple surgical specialties as well as trauma in final analysis. Our matched case series review seems to be the first to compare general surgery, elective operations in patients with and without ESRD with respect to outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Few related studies have been published and those that are available consist of mixed case series including trauma, orthopedic, urologic, and emergency cases. [2][3][4][5][6][7][8][9][10] We sought to determine if patients with ESRD undergoing elective general surgical procedures have higher rates of post operative morbidity and mortality than an otherwise correspondingly diseased general population with normal renal function.…”

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confidence: 99%

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Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

Schneider

Cobb

Patel

et al. 2009

The American Surgeon™

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Little research has been performed in regards to the morbidity and outcomes associated with elective general surgery performed on patients with end stage renal disease (ESRD). With minimal data about the severity of disease in these patients, we sought to quantify the differences in the ESRD patient undergoing elective surgical procedures compared with matched controls. A review of all ESRD patients undergoing elective surgical procedures at a University Medical Center between 2001 and 2005 was performed. Outcomes included length of hospital stay, 1 year morbidity, and mortality. These patients were then compared with a control group with normal renal function matched 2:1. Fifty-two consecutive ESRD patients undergoing elective general surgery procedures were compared with 104 matched controls. The ESRD group experienced more complications (25 vs 16, P = 0.05) and had a larger number of overall complications compared with the controls (33 vs 19, P < 0.05). Length of stay was significantly longer in the ESRD group as well (8 vs 2.65 days, P < 0.0001). Incidence of death (4%) in the ESRD group was increased as well. Patients with ESRD require longer hospital stays and have an increased overall incidence and frequency of complications than patients with normal renal function undergoing elective general surgery procedures. The significantly increased morbidity should be considered when evaluating expected outcomes.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

Schneider

Cobb

Patel

et al. 2009

The American Surgeon™

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“…Hyperkalemia was well controlled in both groups; the K levels being below 5.5 mEq/l, which is thought to be the highest acceptable limit for general anesthesia. 4,6 The K level tended to be somewhat lower The rates of major postoperative complications and the mortality are shown in Table 3, together with the indications for surgery and the operative procedures performed. The major postoperative complications were cardiac failure, cardiac infarction, hepatic failure, respiratory failure, disseminated intravascular coagulation syndrome, and generalized infection.…”

Section: Introductionmentioning

confidence: 98%

Abdominal surgery for patients on maintenance hemodialysis

et al. 1998

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Despite the growing number of major surgical procedures being performed for patients on maintenance hemodialysis, few reports focus on the management and outcome of such patients, especially those undergoing major abdominal surgery. We conducted a retrospective review of 30 patients on maintenance hemodialysis who underwent abdominal surgery, 20 of whom underwent an elective operation and 10, an emergency operation. The indications of elective surgery included gastrointestinal cancer, biliary tract disease, and abdominal aortic aneurysm, while those for emergency surgery mainly involved gastrointestinal perforation or bleeding. There were no statistically significant differences between the elective group and the emergency group regarding either the mean time on hemodialysis or the preoperative clinical data. The morbidity and mortality rates were 15% and 10%, respectively, for the patients who underwent elective surgery and 50% and 70%, respectively, for those who underwent emergency surgery (P < 0.01 and P < 0.05, respectively). Those patients with more than a 2-year history of hemodialysis had a significantly higher mortality rate following abdominal surgery than those with less than a 2-year history (P < 0.01). Thus, the morbidity and mortality rates of patients on maintenance hemodialysis who require major abdominal surgery are significantly high, which reinforces the need to further improve the intensive perioperative management of such patients.

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“…4,5,[8][9][10] Patients with renal failure scheduled for vascular access surgery present a dilemma. Long-term potassium (K) homeostasis is dependent on vascular access for dialysis, yet the surgery to construct this access may be delayed if the patient is hyperkalemic.…”

Section: Objectif : La Décision D'annuler Une Opération D'accèsmentioning

confidence: 99%

“…[1][2][3] Retrospective studies have detected an association between hyperkalemia and increased mortality in hospitalized patients, [4][5][6] and surgical patients, [7][8][9] but reports of perioperative morbidity directly attributable to hyperkalemia are actually quite rare. 4,5,[8][9][10] Patients with renal failure scheduled for vascular access surgery present a dilemma. Long-term potassium (K) homeostasis is dependent on vascular access for dialysis, yet the surgery to construct this access may be delayed if the patient is hyperkalemic.…”

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confidence: 99%

Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery

Olson

Schow

McCann

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The decision to cancel vascular access surgery because of hyperkalemia requires knowledge of the risks vs benefits. This study sought to identify and characterize cases where surgery had been performed in patients with uncorrected hyperkalemia.M Me et th ho od ds s: : One thousand four hundred and seventy-two consecutive cases of vascular access surgery at an academic medical centre between 1995 and 2000 by a single surgeon were analyzed retrospectively.R Re es su ul lt ts s: : Eight cases had clear documentation that the case proceeded with hyperkalemia. Anesthesia techniques were one general anesthetic, one regional block, five monitored anesthesia care (MAC), and one local infiltration only. Mean potassium was 6.9 mmol·L -1 (range 6.1-8.0). In this series of selected asymptomatic hyperkalemic patients undergoing low risk surgery, no adverse results occurred.C Co on nc cl lu us si io on n: : While this review of eight cases (only one receiving general anesthesia) cannot be used to prove the safety of proceeding to surgery with uncorrected hyperkalemia, it does suggest that asymptomatic hyperkalemia may not be an absolute contraindication to vascular access surgery. IGNIFICANT preoperative hyperkalemia is considered a contraindication to anesthesia. Objectif : La décision d'annuler une opération d'accès1-3 Retrospective studies have detected an association between hyperkalemia and increased mortality in hospitalized patients, 4-6 and surgical patients, 7-9 but reports of perioperative morbidity directly attributable to hyperkalemia are actually quite rare. 4,5,[8][9][10] Patients with renal failure scheduled for vascular access surgery present a dilemma. Long-term potassium (K) homeostasis is dependent on vascular access for dialysis, yet the surgery to construct this access may be delayed if the patient is hyperkalemic. The National Kidney Foundation recommends that a vascular access fistula or graft be placed well before the need for dialysis.11 Because these accesses are superior to catheters, 11 delaying this type of surgery in renal failure patients because of hyperkalemia may be counterproductive. The decision to delay because of hyperkalemia requires some knowledge of the hazards associated with proceeding to surgery in the presence of hyperkalemia.

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Surgical Procedures on Patients in End-stage Renal Failure

Cited by 23 publications

References 14 publications

Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

Abdominal surgery for patients on maintenance hemodialysis

Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery

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