Urgent dialysis during hospitalisation for surgery linked to poorer outcomes

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Researchers from Tokyo Medical and Dental University (TMDU) in Tokyo, Japan have found that a need for emergency dialysis during hospitalisation for surgery is strongly associated with functional decline and death after surgery. These findings have been published in the International Journal of Surgery.

“We suspected that patients with impaired kidney function who received urgent dialysis during hospitalisation for surgery would have unfavourable outcomes,” said Shintaro Mandai (TMDU, Tokyo, Japan), senior author of the study. “We were also interested in discovering whether the impact of acute dialysis on patient outcomes varied depending on the type of surgery.”

To investigate this, the researchers analysed data from patients admitted to Japanese hospitals from 2018 to 2019. They specifically looked for connections among type of surgery, type of dialysis, and surgical outcomes.

“The results showed that mortality rates were significantly higher in patients who received acute dialysis,” added Rai Tatemitsu (TMDU, Tokyo, Japan), senior author of the study. “In particular, mortality rates after the two categories of surgical procedures, hepatic lobectomy/cholecystectomy/pancreatectomy and esophagectomy/gastrectomy, were markedly higher when patients needed acute dialysis than when they were already dependent on maintenance dialysis at admission.”

Further analysis showed that having trouble with daily activities, such as bathing and grooming, prior to surgery was strongly associated with death after surgery. Heart surgery, colorectal resection and esophagectomy/gastrectomy in particular led to higher mortality, according to the researchers, while patients who survived heart surgery and orthopaedic surgery were more likely to develop functional challenges after the procedure.

“Our findings demonstrate that patients who undergo postoperative acute dialysis are at much higher risk of mortality than patients on maintenance dialysis,” said Shinichi Uchida (TMDU, Tokyo, Japan), senior author on the study. “Furthermore, mortality risk was not increased with a preoperative dialysis for any surgical procedure.”

These findings suggest that performing dialysis ahead of time for patients with impaired kidney function could enhance the rate of survival, especially after high-risk surgeries, the researchers believe. In addition, given that patients who struggled to carry out daily activities prior to surgery were also at increased risk of death, improving patients’ functional status before surgery could also help improve outcomes, the study findings indicate.

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