Introduction
With each passing year, the number of patients with end-stage renal disease (ESRD)
is increasing steadily, but there are limited data on the postoperative outcomes of
these patients after appendectomy.
Methods
Using the Nationwide Inpatient Sample, we identified all patients who underwent appendectomy
in the United States between 1998 and 2010. We used International Classification of
Diseases, 9th Revision, Clinical Modification codes to identify patients with ESRD
and to track postoperative complications during hospital admission. Statistical models
were controlled for age, sex, race, insurance type, number of Elixhauser comorbidities,
year of admission, perforation of the appendix, and operative approach.
Results
The study population included 5,712 patients with ESRD, with the remaining 3,615,391
patients serving as reference controls. Patients with ESRD had risk of death that
was nearly 5 times greater than controls (odds ratio [OR] 5.68; 95% confidence interval
[95% CI] 3.96–8.15; P < .001); this risk was similar for nonperforated (OR 4.97; P < .001) and perforated (5.96; P = .004) appendicitis. The risk of death, however, was greater for open appendectomy
(OR 6.65; P < .001) compared with laparoscopic appendectomy (OR 2.50; P = .060). Patients with ESRD also were at an increased risk of mechanical wound complication
(OR 1.58; P = .040) and had a mean duration of stay that was 34% greater compared with controls
(P < .001).
Conclusion
Patients with ESRD undergoing appendectomy were at an increased risk of death. These
patients also had an increased risk of mechanical wound complications and had a greater
duration of hospital stay. Future studies should investigate the specific causes of
death among patients with ESRD after appendectomy and optimal management strategies
in this subset of patients.
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Article info
Publication history
Published online: June 08, 2015
Accepted:
March 18,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
