Iannuzzi et al evaluated dialysis-dependent patients undergoing bowel resection. Several risk factors in this population can identify a patient at risk for death or major complications following surgery. The authors are from the University of Rochester.
Outcome following bowel resection: death or major complication. The percentage of patients suffering major complications and/or death is high compared to other patient populations.
This population has a high risk of comorbid conditions including diabetes, hypertension and vascular disease.
Risk Factor
Mortality
Major Complication
acute presentation
Yes
Yes
pulmonary comorbidity
Yes
Yes
cardiac comorbidity
No
Yes
neurologic comorbidity
Yes
No
hypoalbuminemia (serum albumin < 3.5 g/dL)
No
Yes
disability (dependent status)
Yes
No
open surgery
No
Yes
reason for bowel resection
malignancy, vascular insufficiency, perforation
vascular insufficiency, obstruction, “other”
where:
• Acute presentation would encompass emergency and urgent surgeries.
• Diverticulitis was the reference group for the reason for bowel resection. One problem with diverticulitis is that it covers a wide spectrum of disease severity.
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