Mortality and morbidity after hepatic resection in patients undergoing hemodialysis: analysis of a national inpatient database in Japan

Abstract

BackgroundWhether patients undergoing hemodialysis have greater risks of mortality and morbidity after hepatic resection remains unclear. MethodsWe used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify patients who underwent hepatic resection from July 2010 to March 2014. Propensity scorematching analysis was performed to compare morbidity and mortality between patients with and without hemodialysis. ResultsOf 53,651 eligible patients, 498 (0.93%) underwent hemodialysis. Propensity score-matching analysis indicated greater in-hospital mortality in patients with than without hemodialysis (8.6% vs 2.0%; P < .001). Patients undergoing hemodialysis had more postoperative major complications than did patients not undergoing hemodialysis (18.1% vs 7.4%; P < .001). In the subgroup analyses for in-hospital mortality, the odds ratio of hemodialysis was 2.36 (95% confidence interval, 0.78–6.59; P = .067) in limited resection, 4.61 (95% confidence interval, 1.90–11.2; P < .001) in segmentectomy or sectoriectomy, and 5.58 (95% confidence interval, 3.40–14.9; P < .001) in bisectoriectomy or trisectoriectomy. In the age subgroup analyses, the odds ratio of hemodialysis was 4.38 (95% confidence interval, 2.66–7.21; P < .001) in patients aged <80 years and 7.20 (95% confidence interval, 1.55–36.7; P = .0011) in those aged ≥80 years. ConclusionPatients undergoing hemodialysis had a substantially increased risk of mortality and morbidity after hepatic resection. Surgical indications for major hepatectomy in patients undergoing hemodialysis who are ≥80 years of age may be limited and require careful scrutiny.