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Invited Critique
February 2013

Elective Surgery in Dialysis Patients: Realistic Risk Information From the American College of Surgeons National Surgical Quality Improvement Program Database: Comment on “Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis”

Author Affiliations

Author Affiliations: Department of Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.

JAMA Surg. 2013;148(2):143-144. doi:10.1001/2013.jamasurg.363

Nationally validated registries allow investigators to assess “real world” surgical outcomes that are more widely generalizable. In this study using data from the American College of Surgeons National Surgical Quality Improvement Program registry, Gajdos and colleagues found that patients on long-term dialysis undergoing nonemergent procedures are at high risk for complications and have an operative mortality rate of 13%.1 Results from this study represent a more realistic estimate of operative risk in dialysis patients than the 1% to 6% operative mortality rate reported in single-center series.2-4 These findings highlight the importance of dialysis dependence as a risk factor for poor surgical outcomes. It should be considered along with old age and functional dependence as a characteristic that identifies patients at extremely high risk. Identifying high-risk patients informs surgical decision making, allows patients to be appropriately counseled about the risks of surgery, and should prompt efforts aimed at preoperative optimization.

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