Perioperative mortality is linked to chronic renal disease. However, the results of patients who had perioperative acute dialysis had not been determined. For a study, researchers sought to compare the risks of in-hospital mortality and functional deterioration after various procedures that required acute dialysis vs. maintenance dialysis and non-dialysis.

Using an inpatient administrative claims database, they looked at 22,857 patients who had major procedures while hospitalized between 2018 and 2019. Logistic regression models were used to calculate the risks of overall mortality and functional deterioration based on Barthel index values.

Mortality rates in the propensity score-matched groups were 8.54% [95% CI 7.92-9.17], 5.97% (95% CI 5.44-6.50), and 1.12% (95% CI 0.88-1.35) with an acute dialysis requirement, maintenance dialysis, and non-dialysis, respectively. Survivor rates were 7.67% (95% CI 7.07-8.26), 8.56% (95% CI 7.93-9.19), and 3.48% (95% CI 3.07-3.89), respectively, with a  ≥20%- drop in Barthel index values. Lower preoperative Barthel index values were closely linked to death, regardless of surgery. Cardiac surgery, colorectal resection, esophagectomy, and gastrectomy were related to a greater risk of death, whereas orthopedic surgery and cardiac surgery were associated with a higher risk of functional decline. Furthermore, when compared to maintenance dialysis, death rates following hepatic lobectomy/cholecystectomy/pancreatectomy [odds ratio (OR) 3.09, 95% CI 1.61-5.91] and esophagectomy/gastrectomy (OR 2.65, 95% CI 1.68-4.38) were significantly greater with an acute dialysis requirement.

Perioperative acute dialysis was linked with significant risks of death and functional impairment. Several types of procedures resulted in significantly greater acute dialysis fatality rates than maintenance dialysis.