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dc.contributor.authorPalamuthusingam, Dharmenaan
dc.contributor.authorNadarajah, Arun
dc.contributor.authorPascoe, Elaine M
dc.contributor.authorCraig, Jonathan
dc.contributor.authorJohnson, David W
dc.contributor.authorHawley, Carmel M
dc.contributor.authorFahim, Magid
dc.date.accessioned2020-07-28T02:54:25Z
dc.date.available2020-07-28T02:54:25Z
dc.date.issued2020
dc.identifier.issn1932-6203
dc.identifier.doi10.1371/journal.pone.0234402
dc.identifier.urihttp://hdl.handle.net/10072/395869
dc.description.abstractRationale & objective The prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk. Methods A systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565) Results Forty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3–15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2–4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001). Conclusions Patients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherPublic Library of Science (PLoS)
dc.relation.ispartofissue6 June
dc.relation.ispartofjournalPLoS One
dc.relation.ispartofvolume15
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchcode3202
dc.titlePostoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationPalamuthusingam, D; Nadarajah, A; Pascoe, EM; Craig, J; Johnson, DW; Hawley, CM; Fahim, M, Postoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis, PLoS One, 2020, 15 (6 June)
dcterms.dateAccepted2020-05-24
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2020-07-27T03:14:00Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2020 Palamuthusingam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
gro.hasfulltextFull Text
gro.griffith.authorPalamuthusingam, Dharmenaan


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