Key result
Chronic dialysis is linked to ~142% higher odds of postoperative sepsis versus normal kidney function.
Why the study?
Patients on chronic dialysis have increased postoperative mortality after elective surgery, but morbidity outcomes are less often reported and need clarification.
Does chronic dialysis increase postoperative cardiovascular and infectious morbidity in patients undergoing elective surgery compared to normal kidney function?
Meta-Analysis (n=10,557,026)
Does chronic dialysis increase postoperative cardiovascular and infectious morbidity in patients undergoing elective surgery compared to normal kidney function?
Odds Ratio: 2.42 (95% CI 2.12–2.72)
p-value: p=<0.001
Patients on chronic dialysis face significantly higher odds of postoperative cardiovascular and infectious complications, particularly sepsis and myocardial infarction, compared to those with normal kidney function.
Heightened postoperative infection risk persists in dialysis patients after adjustment; leaves open need for refined perioperative risk models.
BACKGROUND: Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS: Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS: Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION: Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
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Palamuthusingam et al. (2021) conducted a meta-analysis in Major non-transplant elective surgery (n=10,557,026). Chronic dialysis vs. Normal kidney function was evaluated on Postoperative sepsis (general surgery, adjusted) (OR 2.42, 95% CI 2.12-2.72, p=<0.001). Patients on chronic dialysis undergoing elective surgery had substantially higher odds of postoperative infectious complications such as sepsis (adjusted OR 2.42) compared to those with normal kidney function.
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