Elective and Emergency Surgery in Chronic Hemodialysis Patients

Figures & data

Table 1. Preoperative clinical characteristics in groups.

	Group 1 (n = 121)	Group 2 (n = 9)	p
Male/female	65/56	5/4	0.675
Age (years)	43.7 ± 2.1	55.3 ± 1.2	0.09
Mean time on hemodialysis (months)	45.2 ± 3	41.5 ± 6.1	0.132
Preoperative data
BUN (mg/dL)	38.7 ± 26.1	42 ± 7.2	0.210
Creatinine (mg/dL)	6.31 ± 2.70	6.46 ± 1.4	0.231
K (mEq/L)	4.6 ± 0.6	5.9 ± 0.8	0.510
Total protein (mg/dL)	5.7 ± 0.2	5.2 ± 0.3	0.05
Hematocrit (%)	26.6 ± 1.6	22.6 ± 1.6	0.09
Platelet (10^3/µL)	248.2 ± 76.2	198 ± 52.4	0.06
Etiology of ESRD (n)
Chronic glomerulonephritis	28 (23 %)	2 (22%)
Diabetes mellitus	24 (20%)	3 (33%)
Primary nephroschleros	14 (12%)	2 (22%)
Chronic pyelonephritis	14 (12%)	1 (11%)
Polycystic kidney	8 (6%)
Vesicoureteral reflux	14 (12%)
No etiology of patients with ESRD (n)	19 (15%)	1 (11%)
Comorbid disease (n)
Cardiovascular disorders	24 (20%)	5 (55%)
Respiratory disease	19 (16%)	3 (33%)
Diabetes	22 (18%)	4 (44%)
ASA score
<3	93	0	0.01
>3	28	9	0.05

Note: Each patient is affected by more than one comorbid disease.

Table 2. Indications for group 1, the type of operations, complications, and mortality in patients on maintenance hemodialysis.

Indications	Number of patients	Elective operations	Complications
Secondary hyperparathyroidism	20 (17%)	Total parathyroidectomy	Cervical hematoma (1)	1
			Recurrent nerve paralysis (1)
			Fistula thrombosis (1)
Secondary hyperparathyroidism	30 (24%)	Subtotal parathyroidectomy	Fistula thrombosis (1)
Nephrolithiasis, polychisytic kidney, infection, and renal cell carcinoma	37 (31%)	Unilateral native nephrectomy (30)	Wound infections (1)
		Bilateral native nephrectomy (7)	Fistula thrombosis (1)
Transplant kidney	16 (13%)	Transplant nephrectomy
Cholelithiasis	8 (7%)	Cholecystectomy
Chronic anal fissure	1 (0.8%)	Lateral internal sphincterotomy
Inguinal hernia	1 (0.8%)	Mesh hernioraphy
Diabetic foot gangrene	6 (5%)	Amputation	Wound infections (2)
Early gastric cancer	1 (0.8%)	Gastric mucosal resection	Atelectasia (1)
Patient with ileostomy	1 (0.8%)	Ileostomy closure
Total patient number; complication and mortality rates	121	121	9 (7%)	1 (0.8%)

Table 3. Indications for group 2, the type of operation, complications, and mortality in patients on maintenance hemodialysis.

Indications	Number of patients	Emergency operations	Complications	Mortality
Diabetic foot gangrene	4 (44%)	Amputation	Wound infections (1)	2
Sigmoid colon obstruction due to sigmoid carcinoma	2 (22%)	Sigmoid resection	Atelectasia (1), wound infection (1)
Fournier gangrenous	1 (11%)	Kolostomi and perineal debritman	Wound infection (2)
Sigmoid volvolus	1 (11%)	Sigmoid resection	Fistula thrombosis (1)
Spontaneous intrarenal hemorrhage	1 (11%)	Nephrectomy + splenectomy (iatrogenic laceration of spleen) Ileostomy	Pancreatic fistula (1)
Complication and mortality	9	10	7 (70%)	2 (20%)