SURGERY IN CHRONIC DIALYSIS PATIENTS

During recent years there has been a continuous increase in the number of patients with end-stage renal failure who require long-term dialys is. The purpose of this retrospective work was to look at the number a nd type of operations performed and the postoperative outcome and comp lications that may be typical for these patients. This report details our experience with surgery in chronic dialysis patients, focusing mai nly on major surgical procedures. During 21 years (1972-93) 22 patient s on long-term hemodialysis or peritoneal dialysis underwent 44 operat ions. All access operations and parathyroidectomies were excluded. Eac h patient underwent between 1 and 6 operations; 27 (61.4%) operations were elective and 17 (38.6%) were emergencies. The most common type of operation performed was abdominal surgery and hernia repair; the othe rs, in decreasing order, were urological operations, amputations, and vascular surgery. Postoperative complications occurred in 54% of the o perations, the most common being hyperkalemia in 32%, infectious compl ications in 16%, and bleeding in 11%. One patient (2%) died postoperat ively; the cause was most probably secondary to hyperkalemia and a fat al arrhythmia. From a review of the literature and from the results of our study it appears that surgery in uremic patients can be performed with acceptable results in terms of morbidity and mortality rates. Co mplications, such as hyperkalemia, a fall in blood pressure, and bleed ing, are expected and preventive measures should therefore be taken. P erioperative measures are recommended to minimize complications.