New England Surgical Society

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Preoperative factors associated with major bleeding in patients with ESRD undergoing elective abdominal surgeries: a retrospective NSQIP cohort study
*Joy Zhou, Sivamainthan Vithiananthan
Warren Alpert Medical School of Brown University, Providence, RI

Objective: To describe the prevalence and risk factors for major bleeding in ESRD patients undergoing elective abdominal surgeryDesign: Retrospective cohort studySetting: Participating American College of Surgeons-National Surgical Quality Improvement Program (ACS NSQIP) hospitals between 2005-2017Patients: Patients age 18 and older on current dialysis who underwent a number of elective abdominal surgery procedures at a participating ACS NSQIP hospital, as defined by primary procedure CPT code: appendectomies, hepatobiliary surgeries, colorectal surgeries, gastric surgeries, splenic surgeries, and herniorrhaphies.Main Outcome Measures: Major bleeding, defined as bleeding requiring transfusion within 72 hours of surgery start time. 30-day mortality was studied as a secondary outcome.Results: Among 12,918 patients, the major bleeding rate was 11.5% and 30-day mortality was 5.8%. Major bleeding rates were highest among patients who underwent pancreatic surgeries (37.6%), hepatic surgeries (33.7%), splenic surgeries (33.0%), and open colectomies (29.1%). Major bleeding was likelier in patients who were hypoalbuminemic, anemic, thrombocytopenic, uremic, inpatients, and in those who required a preoperative transfusion (p<0.001). INR>1.5 was independently associated with increased odds of major bleeding and 30-day mortality. The 30-day mortality rate was highest in patients who underwent colostomies or ileostomies (16.8%), open colectomies (16.4%), and pancreatic biopsy, drainage, or debridement procedures (16.4%). Patients who experienced major bleeding had higher odds of 30-day mortality (OR=1.68, 95% CI 1.34-2.11, p<0.001). Conclusions: Patients with ESRD face high rates of major bleeding following elective abdominal surgery. Future studies should investigate whether correction of preoperative lab derangements reduced risk of major bleeding. Because major bleeding is independently associated with increased postoperative mortality, the risks and benefits should be given careful consideration prior to proceeding with elective abdominal surgery in this population.


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