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New research provides important insights into the care of women with kidney failure on chronic kidney replacement therapy (KRT) undergoing gynecologic surgery, according to a study published in the International Journal of Gynecology & Obstetrics.

David Johnson, PhD, MBBS, and colleagues conducted a retrospective, observational cohort study using binational data linkage. They 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 endpoint was in-hospital or 30-day mortality. Secondary endpoints included in-hospital or 30-day mortality, infectious complications, medical complications, wound complications, transfusion requirement, ICU admissions, readmissions, length of stay, and dialysis/transplant-specific outcomes. Univariable and multivariable logistic and negative binomial regression models were used.

 The study included 403 patients, including 30.5% who underwent abdominal hysterectomy, 19.1% who had a vaginal hysterectomy, and 50.4% who had ovarian surgery. The median age at surgery was 51 years.

Complications Vary by Surgical Approach, KRT Modality

The researchers reported that the 15-year study showed 30-day mortality and morbidity rates of 1.2% (95% CI, 0.5-3.0) and 30.8% (95% CI, 26.3-35.6), respectively. They noted mortality was low and predominantly caused by intra-abdominal surgical pathology. Of the cohort, 30.8% experienced at least one complication postoperatively.

Complication rates varied by surgical approach and KRT modality. When compared with abdominal hysterectomy, patients undergoing vaginal hysterectomy had statistically significant lower odds of transfusion (adjusted OR [aOR], 0.40; 95% CI, 0.16-0.98), ICU admission (aOR, 0.28; 95% CI, 0.09-0.80) and shorter length of stay (incidence rate ratios [IRR], 0.74; 95% CI, 0.55-0.99). This group also trended toward fewer infectious, medical, and wound complications.

Of all KRTs, postoperative mortality was highest in patients on peritoneal dialysis (6.9%; 95% CI, 1.2-24.2; P=0.026). This group also required more transfusions (aOR, 2.84; 95% CI, 1.12-7.21) and longer hospital stays (IRR, 1.58; 95% CI, 1.07-2.33). Kidney transplant recipients had significantly lower rates of ICU admissions (aOR, 0.22; 95% CI, 0.09-0.52) and shorter hospitalizations (IRR, 0.75; 95% CI, 0.58-0.96). Among this cohort, the researchers also observed fewer 30-day readmissions (15.3%) and transfusions (12.1%) compared with the other KRT modalities.

Advanced age and emergency admissions correlated with worse outcomes. Emergency admissions were associated with significantly higher rates of infective and wound complications, transfusions, ICU admission, and prolonged hospitalization, the findings showed.

“Further research into risk mitigating strategies should be pursued for this vulnerable patient population,” Dr. Johnson and colleagues wrote.