Preoperative Factors Associated with Major Perioperative Bleeding in End-Stage Renal Disease Patients on Long-Term Dialysis Undergoing Non-Elective Abdominal Surgeries
Claire A. Ostertag-Hill*1, Joy Zhou Done3, Olivia Ziegler3, Siva Vithiananthan2
1Surgery, Rhode Island Hospital/Brown University, Providence, RI; 2Surgery, Miriam Hospital/Brown University, Providence, RI; 3The Warren Alpert Medical School of Brown University, Providence, RI
Objective
To determine the prevalence and risk factors for perioperative bleeding in patients on dialysis undergoing non-elective abdominal surgery
Design
Retrospective cohort study
Setting
Participating American College of Surgeons-National Surgical Quality Improvement Program (ACS NSQIP) hospitals between 2005-2017
Patients (or Other Participants)
Patients age 18 and older on current dialysis who underwent a number of non-elective abdominal surgery procedures at a participating ACS NSQIP hospital, as defined by primary procedure CPT code.
Interventions (if any)
None
Main Outcome Measure (s)
Major perioperative bleeding, defined as bleeding requiring transfusion within 72 hours after surgery, and risk factors for major perioperative bleeding.
Results
Of 9,102 patients on dialysis undergoing non-elective abdominal surgery, 2,793 (30.7%) experienced major perioperative bleeding requiring transfusion, and 2,002 (22%) died within 30 days of surgery. By multivariable logistic regression, patients who were female, dependent in ADLs, ventilator-dependent, had disseminated cancer, or had chronic steroid use were at elevated risk for major perioperative bleeding. Elevated PTT, BUN, anemia, and hypoalbuminemia were also associated with higher odds of major bleeding. Compared to patients undergoing herniorrhaphy (lowest risk), the odds of major perioperative bleeding were highest for patients undergoing hepatic (OR=18.09), splenic (OR=10.86), and pancreatic surgery (OR=9.59). Major perioperative bleeding was associated with increased 30-day mortality (34.0% vs. 16.7%, p<0.001).
Conclusions
Patients with ESRD experience high rates of bleeding requiring transfusion following emergent abdominal surgery. Derangements in preoperative labs and baseline patient characteristics may be useful in assessing bleeding risk in this patient population.
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