Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Mar 18;22(1):97.
doi: 10.1186/s12882-021-02279-0.

Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis

Dharmenaan Palamuthusingam  1   2   3 , Arun Nadarajah  4 , David Wayne Johnson  5   6   7 , Elaine Marie Pascoe  8 , Carmel Marie Hawley  5   6   8 , Magid Fahim  6   8
Affiliations
Meta-Analysis

Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis

Dharmenaan Palamuthusingam et al. BMC Nephrol. .

Abstract

Background: Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis.

Methods: Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity.

Results: Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72).

Conclusion: Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.

Keywords: Chronic dialysis; End-stage kidney failure; Infection; Perioperative morbidity; Surgery.

PubMed Disclaimer

Conflict of interest statement

DP has received speaking honoraria from the Australian Medical Forum. DJ is a current recipient of an Australian National Health and Medical Research Council Practitioner Fellowship. DJ has previously received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care. CH has received funding from Janssen and GlaxoSmithKline to her institution for trial steering committee roles and research grant support to her institution from Shire, Baxter, Fresenius, and Otsuka and travel sponsorship from Otsuka.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection
Fig. 2
Fig. 2
Cardiovascular Complications. a Postoperative myocardial infarction odds for patients on chronic dialysis. b Postoperative stroke odds for patients on chronic dialysis
Fig. 3
Fig. 3
Postoperative Infectious Complications. a Postoperative sepsis odds for patients on chronic dialysis. b Postoperative surgical site infection odds for patients on chronic dialysis
See this image and copyright information in PMC

References

    1. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. 2012;380(9847):1059–65. - PMC - PubMed
    1. Gajdos C, Hawn MT, Kile D, Robinson TN, Henderson WG. Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis. JAMA Surgery. 2013;148(2):137–143. - PubMed
    1. Liu JY, Birkmeyer NJO, Sanders JH, Morton JR, Henriques HF, Lahey SJ, et al. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Circulation. 2000;102(24):2973–2977. - PubMed
    1. Palamuthusingam D, Nadarajah A, Pascoe EM, Craig J, Johnson DW, Hawley CM, et al. Postoperative mortality in patients on chronic dialysis following elective surgery: a systematic review and meta-analysis. PLoS One. 2020;15(6):e0234402. - PMC - PubMed
    1. Carlisle J. Pre-operative co-morbidity and postoperative survival in the elderly: beyond one lunar orbit. Anaesthesia. 2014;69(s1):17–25. - PubMed

Publication types

MeSH terms