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Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
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Recognizing risk: bowel resection in the chronic renal failure population.

James C Iannuzzi1, Andrew-Paul Deeb, Aaron S Rickles

  • 1Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA. james_iannuzzi@urmc.rochester.edu

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|September 14, 2012
PubMed
Summary

Bowel resection in patients with stage 5 chronic kidney disease carries a high mortality risk. Optimizing comorbid conditions and considering laparoscopy may improve outcomes for these high-risk surgical patients.

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Area of Science:

  • Nephrology
  • Surgical Outcomes
  • Public Health

Background:

  • Limited data exists on the impact of chronic kidney disease (CKD) on abdominal surgery outcomes.
  • Stage 5 CKD patients undergoing major surgery face significant risks.
  • This study addresses the knowledge gap regarding bowel resection in dialysis-dependent CKD patients.

Purpose of the Study:

  • To identify predictors of risk and outcomes for bowel resection in patients with stage 5 CKD.
  • To analyze mortality and morbidity in this specific patient population.
  • To inform clinical practice for managing CKD patients requiring abdominal surgery.

Main Methods:

  • Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2005-2010).
  • Included dialysis-dependent patients undergoing major bowel resection.
  • Assessed patient demographics, preoperative risk factors, and intraoperative variables using multivariate regression.

Main Results:

  • 1,685 patients with CKD undergoing bowel resection were analyzed.
  • Overall 30-day mortality was 27.5% and morbidity was 58.3%.
  • Key mortality predictors included acute presentation, hypoalbuminemia, pulmonary, and cardiac comorbidities.

Conclusions:

  • Bowel resection in stage 5 CKD patients is associated with high mortality.
  • Preoperative optimization of comorbidities is crucial for reducing mortality.
  • Laparoscopic approaches may decrease postoperative morbidity and should be preferred.