Dr Dharmenaan Palamuthusingam1, Professor CARMEL M HAWLEY2, Ms. ELAINE M PASCOE3, Professor DAVID W JOHNSON2, A/Prof. PALVANNAN SIVALINGAM2, Professor STEPHEN MCDONALD4, Professor NEIL BOUDVILLE5, Professor MATTHEW JOSE6, A/Prof. GIRISH TALAULIKAR7, Dr NICK CROSS8, Dr MAGID FAHIM2
1Royal Brisbane And Womens Hospital, Herston, Australia, 2Princess Alexandra Hospital, Woolloongabba, Australia, 3University of Queensland, Herston, Australia, 4ANZDATA, Adelaide, Australia, 5University of Western Australia, Perth, Australia, 6Royal Hobart Hospital, Hobart, Australia, 7Canberra Hospital, Canberra, Australia, 8Canterbury District Health Board, Canterbury, New Zealand
Background:
Patients receiving chronic kidney replacement therapy (KRT) have increased risks of postoperative mortality and morbdity. Contemporary data on the rates of gastrointestinal (GI) surgery these patients undergo are lacking. This study assessed the trends of gastrointestinal (GI) surgery and postoperative mortality rates over a 15-year period.
Methods:
This bi-national population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets. A logic-based algorithm was derived for data contextualisation. Patients were categorised by their KRT modality (hemodialysis [HD], peritoneal dialysis [PD], home hemodialysis [HHD] and kidney transplant [KT]) for each calendar year. Adjusted surgery rates were estimated using Poisson models. Logistic regression was used to estimate mortality risk. Independent predictors of 30-day-mortality were examined using comorbidity-adjusted Cox models.
Results:
Of 46,707 patients followed over a median [IQR] 6.3years [3.5 – 10.2], 9,116 underwent 10,379 GI surgeries, with 3,109 patients undergoing 2 or more surgeries. GI surgery rates were highest in PD patients and lowest in KT recipients (7.9 vs. 3.6 per 100 patient years). Overall surgery rates did not appreciably change during the study. Hernia repair was the most common GI surgery, followed by bowel surgery. Adjusted annual 30-day postoperative mortality rates decreased by 47% over the study period from 11.5% to 6.1%. Age >65years (HR: 1.8, 95%CI 1.2-2.7), KRT vintage >5yrs (HR 2.4, 95%CI 1.3-4.4), emergency presentation (HR 2.3, 95%CI 1.5-3.6) and previous surgery within 30-days (HR 5.9, 95%CI 1.5-22.5) were independently associated with mortality. Perforated abdominal viscus was the most common cause of death.
Conclusions:
Rates of GI surgery have remained stable. Post-operative mortality is over 6% and associated with older age, longer KRT duration, recent surgery and emergency presentation.
Biography:
Dr. Dharmenaan Palamuthusingam is a senior staff specialist in Nephrology at Royal Brisbane and Womens Hospital, Queensland. He holds an academic appointment as a Senior Lecturer in Clinical Medicine with both the University of Queensland and Griffith University. Dr. Palamuthusingam is currently completing his PhD with University of Queensland looking at the perioperative outcomes and risk assessment of people on chronic dialysis and kidney transplant recipients who undergo surgery. He has presented his research at national and international conferences and has received both local and national awards for his work.