Open AccessEffect of chronic renal failure on postoperative mortality rate following arterial reconstruction
Author(s) -
Ray S. A.,
KeastButler O. D.,
Wood C. M.,
Scoble J. E.,
Taylor P. R.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01420-60.x
Subject(s) - medicine , surgery , dialysis , mortality rate , respiratory failure , creatinine , kidney disease , thrombosis , stroke (engine) , cardiology , mechanical engineering , engineering
Background: Chronic renal failure (CRF) is both a risk factor for, and a consequence of, peripheral arterial disease. There is also increasing evidence that patients with CRF have a higher mortality rate following arterial reconstruction, but it is not known whether this is different for aneurysmal or occlusive disease. Methods: Over 8 years 1718 consecutive arterial reconstructions performed under the care of one consultant were studied prospectively. Patients were defined as having CRF if at the time of surgery the serum creatinine measured more than 400 μmol 1 −1 , they were undergoing dialysis or they had received a renal transplant. The in‐hospital postoperative mortality rate was compared between patients with and without CRF and analysed according to the urgency as well as the type of arterial reconstruction. Results: Sixty‐nine patients (4 per cent) undergoing arterial reconstruction over the study period were defined as having CRF. Sixteen (23 per cent) of these died following surgery (myocardial infarct seven, multiple organ failure three, stroke one, mesenteric thrombosis one, paraplegia one, respiratory failure one, pneumonia one, failure to thrive one), in comparison to 120 (7·3 per cent) of 1649 patients without CRF. The mortality rate in patients with CRF was highest in those who underwent urgent/emergency surgery and those who had reconstruction for occlusive disease.CRF No CRF PNo. Deaths No. DeathsElective 51 9 (18) 1103 43 (3·9) < 0·01 Urgent/emergency 18 7 (39) 546 77 (14·1) < 0·01 Thoracic/aortic aneurysm 35 8 (23) 391 54 (13·8) n.s. Infrainguinal bypass 14 5 (36) 387 25 (6·5) < 0·01Values in parentheses are percentages. n.s., Not significantConclusion: Patients with CRF have a threefold increase in mortality rate following arterial reconstruction. Patients undergoing infrainguinal bypass are at particular risk and should be carefully selected and counselled. © 2000 British Journal of Surgery Society Ltd