Rising rate of dialysis after major surgery

In Ontario, the use of short-term dialysis after elective major surgery has increased sharply since the mid-1990s, reports a study in the Canadian Medical Association Journal.

Using Ontario health databases, the researchers analyzed more than 550,000 adults undergoing elective major surgery between 1995 and 2009. Trends in the rate of short-term dialysis (within 14 days) after surgery were analyzed, along with the outcomes of death within 90 days and the need for long-term dialysis.

The analysis included 2231 patients receiving short-term dialysis—overall rate 0.4 percent. However, the rate of short-term dialysis increased steadily: from 0.2 percent in 1995 to 0.6 percent in 2009. Patients undergoing cardiac and vascular surgery accounted for most of the increase. After cardiac surgery, the rate of short-term dialysis increased from 1 in 390 patients to 1 in 85 patients. The trend remained significant after adjustment for patient and surgical characteristics: odds ratio 1.7.

The 90-day mortality in patients receiving short-term dialysis was 42.0 percent, with no change over time. Of 1294 patients who received short-term dialysis and survived, 27.2 percent received dialysis.

The rates of short-term dialysis after surgery appear to be increasing. It is particularly important to understand the trends and outcomes of short-term dialysis associated with elective surgical procedures.

This study documents a substantial increase in the use of short-term dialysis after elective major cardiac and vascular surgery. The associated rates of death and long-term dialysis are stable and high. The results highlight the need for better approaches to the prevention and treatment of acute perioperative kidney injury [Siddiqui NF, et al. Secular trends in acute dialysis after elective major surgery—1995 to 2009. CMAJ 2012; 184:1237–1245].