Dialysis Patients Face High Risks After Emergency Abdominal Surgery

Dialysis patients who underwent nonelective (immediate) abdominal surgery faced significant health risks like bleeding, myocardial infarction, stroke, and death (1^✔ ✔Trusted Source
Major Perioperative Bleeding in Patients on Dialysis Undergoing Nonelective Abdominal Surgeries

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Emergency Abdominal Surgery in Dialysis patients

The study was conducted by Sivamainthan Vithiananthan, MD, of Brown University Warren Alpert Medical School in Cambridge, Massachusetts, and colleagues. They analyzed the American College of Surgeons National Surgical Quality Improvement Program database from 2005-2017 and found 9.102 dialysis patients who had emergency abdominal surgeries.

The study found that 30.7% of patients experienced severe perioperative bleeding (around the time of operation) within 72 hours of surgery, requiring a blood transfusion. About 22% of patients died within 30 days. Patients with perioperative bleeding when compared with patients without perioperative bleeding were more likely to experience heart attacks (3.4% vs. 1.9%), major cardiovascular complications (16.9% vs. 6.1%), strokes (1.8% vs. 1.1%), and a higher death rate (34% vs. 16.7%).

Certain types of emergency surgeries were found to carry an extremely high risk of major bleeding. Patients who had liver surgery were 18.1 times more likely to experience severe bleeding than those undergoing low-risk procedures, such as hernia repair. Similarly, spleen surgery carried a 10.9-fold increased risk, while pancreatic surgery increased the risk 9.6 times.

Who Is at Higher Risk of Bleeding After Surgery?

Major bleeding risk was higher in women patients with disseminated cancer (cancer that has spread) or those dependent on a ventilator and chronic steroid users. However, patients who were independent or partially dependent in performing their daily activities were more likely to experience bleeding compared to those who were fully dependent on caregivers.

Other pre-existing medical conditions were linked to an increased risk of bleeding. Patients with preoperative low protein levels (hypoalbuminemia), anemia, high blood urea nitrogen (BUN) levels, high levels of partial thromboplastin time (PTT - blood clotting abnormalities), and those who had a preoperative blood transfusion were at high-risk bleeding and requires a blood transfusion after surgery.

Identifying these risks before surgery could help doctors take necessary precautions. This can allow surgeons to adjust their techniques to minimize bleeding with close monitoring and early identification of bleeding events postoperatively.

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Reference:

1. Major Perioperative Bleeding in Patients on Dialysis Undergoing Nonelective Abdominal Surgeries - (https://pubmed.ncbi.nlm.nih.gov/39733473/)

Source-Medindia