Nationwide mortality associated with perioperative acute dialysis requirement in major surgeries

Chronic kidney disease is associated with perioperative mortality. However, outcomes of patients who perioperatively received acute dialysis have not been clarified. We aimed to determine risks for in-hospital death and functional decline following various surgeries with an acute dialysis requirement versus maintenance dialysis and non-dialysis.

We analyzed 22,857 patients who underwent major surgeries during hospitalization in Japan from 2018 until 2019 using an inpatient administrative claims database. Risks of overall death and functional decline assessed by Barthel index scores were determined with logistic regression models.

Among the propensity score-matched groups, mortality rates were 8.54% [95% confidence interval (CI) 7.92-9.17], 5.97% (95% CI 5.44-6.50), and 1.12% (95% CI 0.88-1.35) with an acute dialysis requirement, maintenance dialysis, and non-dialysis, respectively. The survivor rates with ≥20%-decline in Barthel index scores were 7.67% (95% CI 7.07-8.26), 8.56% (95% CI 7.93-9.19), and 3.48% (95% CI 3.07-3.89), respectively. Lower preoperative Barthel index scores were strongly associated with mortality independent of surgeries. Cardiac surgery, colorectal resection, esophagectomy, and gastrectomy led to higher mortality, while cardiac surgery, and orthopedic surgery were associated with higher risk of functional decline. In addition, mortality rates after hepatic lobectomy/cholecystectomy/pancreatectomy [odds ratio (OR) 3.09, 95% CI 1.61-5.91] and esophagectomy/gastrectomy (OR 2.65, 95% CI 1.68-4.38) were markedly higher with an acute dialysis requirement when compared with maintenance dialysis.

Perioperative acute dialysis requirements were associated with substantial risks for mortality and functional decline. Several types of surgeries led to even higher mortality rates for acute dialysis than maintenance dialysis.