Factors Affecting Postoperative Morbidity and Mortality in Chronic Hemodialysis Patients

Objectives: Hemodialysis (H/D) is the most common renal replacement therapy for patients with end-stage renal failure (ESRD). Although cardiac and neurological complications associated with the treatment are known to increase mortality, the effect of surgical interventions on patients is not fully elucidated. Therefore, we aimed to determine the effect of surgery on morbidity and mortality in H/D patients as a specific group.

Methods: The data of 117 patients who received HD treatment for ESRD were analyzed retrospectively.

Results: Among the surgical subgroups, medium-sized (43.5%), elective (66.6%) and extra-abdominal (58.1%) surgeries were performed at the highest rate. Those undergoing emergency surgery were older and had a higher rate of anemia, lower albumin levels, and higher C-reactive protein (CRP) levels compared to other groups (p<0.05). Similarly, the mean age and creatinine levels of those who underwent major surgery were higher (p<0.05). The mean age and CRP levels of those undergoing abdominal surgery were higher compared to other groups (p<0.05). The multivariate analysis has shown that advanced age, low albumin levels, and emergency, intra-abdominal and major surgeries are independent prognostic risk factors for ICU admission. Advanced age, low albumin level, and emergency surgery were the determining factors for 1-month postoperative mortality.

Conclusion: Emergency, major, and intra-abdominal surgery significantly increase morbidity and mortality in chronic H/D patients. Further, hypoalbuminemia and advanced age are independent prognostic factors for higher intensive care unit admission. Preoperative elevation of albumin levels along with close postoperative follow-up may positively affect survival in these patients.