Objective This study evaluates postoperative outcomes of patients with kidney failure on chronic kidney replacement therapy after gynecological surgery.

Methods This binational data-linkage study identified patients with kidney failure via the Australia and New Zealand Dialysis and Transplant Registry who underwent major gynecological surgeries between 2000 and 2015. The primary outcome was postoperative mortality. Secondary outcomes included infective, medical, and wound complications, transfusion requirement, intensive care unit (ICU) admissions, readmissions, length of stay, and dialysis/transplant-specific outcomes. Univariable and multivariable logistic and negative binomial regression models were used.

Results Among the 403 patients included, 30.5% underwent abdominal hysterectomy, 19.1% vaginal hysterectomy and 50.4% ovarian surgery. Thirty-day mortality and morbidity rates were 1.2% (95% confidence interval [CI]: 0.5–3.0) and 30.8% (95% CI: 26.3–35.6), respectively. Compared with abdominal hysterectomy, vaginal hysterectomy was associated with fewer transfusions (adjusted odds ratios [aOR]: 0.40, 95% CI: 0.16–0.98), ICU admissions (aOR: 0.28, 95% CI: 0.09–0.80), and shorter stays (IRR: 0.74, 95% CI: 0.55–0.99). Of all kidney replacement therapies, postoperative mortality was highest in patients on peritoneal dialysis (6.9%, 95% CI: 1.2–24.2, P = 0.026). This cohort also required more transfusions (aOR: 2.84, 95% CI: 1.12–7.21) and had longer stays (IRR: 1.58, 95% CI: 1.07–2.33). Kidney transplant recipients had fewer ICU admissions (aOR: 0.22, 95% CI: 0.09–0.52) and shorter stays (IRR: 0.75, 95% CI: 0.58–0.96). Emergency admissions and older age correlated with poorer outcomes.

Conclusion Patients on chronic kidney replacement therapy undergoing gynecological surgery demonstrated low postoperative mortality but substantial morbidity. Further research is needed to evaluate risk-mitigating strategies.