A. Akhtar1, E. Robinson1, A. Sill1, G. Hayward1 1Saint Agnes Hospital,Surgery,Baltimore, MD, USA
Introduction:
Over the past two decades, laparoscopic peritoneal dialysis catheter (LPDC) insertion has been the standard and preferred method of establishing peritoneal dialysis access over open and percutaneous techniques. Various risk factors can influence the perioperative morbidity due to post-surgical complications that stem from LPDC insertion. The literature base offers only a few published studies regarding risk factors associated with LPDC catheter placement in an adult population.This study was conducted to investigate perioperative risk factors associated with complications after LPDC catheter insertion in an adult population.
Methods: A retrospective review of patients undergoing LPDC catheter insertions were identified from the American College of Surgeons National Surgical Quality Initiative Project (NSQIP) database using current procedural terminology (CPT) codes between 2007-2016. Bivariate analyses, chi-square and student T-tests were used to compare predictors of post-surgical morbidity between those who had and did not have LPDC placements. Binary logistic regression was used to calculate the odds of morbidity and mortality for each predictor.
Results: Of the 2,691,480 general surgeries between 2007 and 2016, 7679 (.3%) laparoscopic peritoneal catheters were placed. This number has trended upward from 417 in 2007 to 1488 in 2016 suggesting the acceptability of laparoscopic approach for peritoneal catheter placement. Post-operative deep SSIs were associated with low albumin (OR 1.77), increased surgery duration (OR 1.28) and inpatient status (ORs 3.1). Post-operative organ space SSIs were associated with increased operative time (OR 1.5), INR (1.3) and inpatient status (OR 3.1). Post-operative wound disruption was associated with a history of congestive heart failure (OR4.1), steroid use (2.6), inpatient status(ORs 2.4) and hypertension (OR 1.5).Mortality was increased in higher ASA class( OR 2.89), inpatient status(OR 2.3), old age(OR 2.2), steroid dependent(OR 1.87), low hematocrit (OR 1.78) and higher BUN (OR 1.44).
Conclusion:LPDC is a safe and widely practice approach for establishing effective peritoneal dialysis access. Infectious complications are strongly associated with inpatient status, hypoalbuminemia and increase OR time while wound complications occur more in patients who have congestive heart failure, hypertension and steroid dependent. A larger proportion of PD patients transfer to hemodialysis can be prevented by adopting elective surgery and controlling pre-operative heart failure, hypertension and minimizing steroid use. Mortality predictors are higher ASA class and old age
