Safety analysis of primary bariatric surgery in patients on chronic dialysis.

Abstract

Due to the steady increase in patients on chronic dialysis, more of these patients are undergoing elective operations. The literature on safety and postoperative outcomes in dialysis-dependent patients following elective bariatric surgery is scant. We compared the 30-day major morbidity and mortality rates in dialysis-dependent (DD) and non-dependent (ND) patients after primary bariatric surgery. From American College of Surgeons National Surgical Quality Improvement Program, we identified patients, who underwent primary bariatric surgery between 2005 and 2013. Thirty-day postoperative outcomes were compared between DD and ND patients. Logistic regression was used to determine the prognostic impact of dependence on chronic dialysis on the 30-day postoperative outcomes. Two hundred and thirty-four DD and 113,677 ND patients were analyzed. DD patients had a higher baseline risk profile compared to ND patients. Thirty-day mortality rates for DD and ND patients were 0.43 and 0.11%, respectively (P=0.134). DD patients had a higher 30-day major morbidity compared to ND patients (5.98 vs. 2.31%; P<0.001, respectively). Despite a crude OR of 2.70 (95% CI 1.57-4.63) after adjusting for confounding, dependence on dialysis was not found to be an independent predictor of major morbidity. Primary bariatric surgery is safe in patients dependent on dialysis with an acceptable 30-day postoperative morbidity and mortality. Even though dependence on dialysis does not independently increase the risk of 30-day adverse outcomes following primary bariatric surgery, the comorbid conditions in this patient population render them at risk. The higher prevalence of major morbidities in this group is mainly due to the impact from older age, male sex, higher BMI, cardiac comorbidities, and hypertension.