May 1981

Surgery, Nutritional Support, and Survival in Patients With End-Stage Renal Disease

Author Affiliations

From the Department of Surgery, Section of Transplantation (Drs Giacchino, Geis, and Wittenstein), and the Department of Medicine, Section of Nephrology (Drs Bansal, Gandhi, and Vertuno), Loyola-Stritch School of Medicine and Hines Veterans Administration Hospital, Maywood and Hines, Ill.

Arch Surg. 1981;116(5):634-640. doi:10.1001/archsurg.1981.01380170114021

• In 216 patients with end-stage renal disease (ESRD) undergoing 406 major operations, surgery was elective in 143 cases (mortality, 1.4%) and nonelective in 263 (mortality, 11.1%). Of 82 patients who received 105 pretransplant operations to prevent posttransplant complications, eg, gastrointestinal hemorrhage, urinary tract sepsis, and azathioprine intolerance, surgical mortality was 1.9%, with 80 patients becoming active candidates for transplantation. Sepsis requiring surgical care occurred in 54 patients, in 36 of these in the posttransplant period. Parenteral and enteral hyperalimentation was used as a therapeutic adjunct in 40 of these patients. Overall mortality in those with septic complications was 35.2%, 22.5% in the nutritional support group and 71.4% in the group not receiving hyperalimentation. Improved survival rates can be achieved for surgical emergencies in ESRD, particularly in the posttransplant immunosuppressed patient, if both definitive surgical intervention and nutritional support are actively applied.

(Arch Surg 1981;116:634-640)