Kidney transplant recipients (KTR), like the general population, often require surgical procedures for non-transplant related issues. Given the need for lifelong immunosuppression and the physiologic impact of years of renal replacement, we hypothesized that colectomy might have higher risks for KTR. We investigated the differences in morbidity, LOS, and cost between KTR and non-KTR undergoing colectomy at both transplant and non-transplant centers nationwide.

METHODS: The National Inpatient Sample was used to study 2,345 adult KTR and 1,394,798 non-KTR who underwent colectomy between 2000-2013. Morbidity, defined as postoperative complications, was identified by ICD-9 code. Complication rates, LOS, and cost were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively.

RESULTS: The mortality rate among KTR was higher than for non-KTR (11.1 vs 4.3%, p <0.001). Morbidity was also higher (38.5 vs 31.5%, p =0.001)(Table 1). Following adjustment for patient and hospital level factors, mortality (OR 3.21, 95%CI 2.40-4.31) and morbidity (OR 1.23, 95%CI 1.02-1.48) were both increased in KTR (Table 2). Mean length of stay was longer (17 vs 10 days, p <0.001; adjusted ratio 1.48, 95%CI 1.40-1.57) and mean hospital costs were higher ($42,342 vs 22,265, p<0.001; adjusted ratio 1.51, 95%CI 1.41-1.62) for KTR. These findings were similar regardless of whether colectomy was performed at a transplant center.

CONCLUSION: KTR have higher mortality, greater postoperative morbidity, longer length of stay, and higher hospital-associated costs than non-KTR undergoing colectomy. Undergoing surgery at a transplant center does not attenuate these findings. Physicians should consider these elevated risks when planning for surgery in the KTR population and counsel patients accordingly.

CITATION INFORMATION: DiBrito S, Alimi Y, Holscher C, Olorundare I, Segev D, Garonzik-Wang J. Outcomes Following Colectomy in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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