Diabetics Face More Surgeries After Starting HD

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SEATTLE—The frequency of surgical operations increases in diabetics after the start of hemodialysis (HD), according to researchers. The main reason is an increase in the frequency of amputations for gangrene.

In addition, among men with and without diabetes, vascular diseases—both cardiac and peripheral—account for the vast majority of surgical operations before HD and after starting HD.

Milagros Martinez, MD, of the New Mexico VA Medical Center and the University of New Mexico in Albuquerque, analyzed surgical procedures in 175 male HD patients in the pre-HD and HD periods. The group included 121 patients with diabetes and 54 without diabetes. The mean age at the start of HD was 64 years for the diabetics and 66 for those without diabetes.

The frequency of operations other than those related to dialysis access (per patient per year) rose significantly from 0.21 in the pre-HD period to 0.58 in the HD among diabetics and nonsignificantly from 0.25 to 0.34 in the non-diabetics, the investigators reported here at the 30th Annual Dialysis Conference.

In diabetic population, 102 operations occurred in the pre-HD period. The most frequent types of operations were amputations for gangrene (29.4%), coronary artery bypass (15.7%), corrective orthopedic procedures (8.8%), laparotomies (6.9%), and 5.9% each for deep abscess drainage, peripheral vascular surgery, and eye surgeries.

In the HD period, 143 procedures were performed. Amputations due to gangrene accounted for 52.4% of operations. Trauma surgery, coronary artery bypass, and deep abscess drainage accounted for 14.7%, 6.3%, and 4.9%, respectively. Peripheral vascular surgery, laparotomies, and corrective orthopedic procedures each account for 4.2%.

In the non-diabetics, 37 operations took place in the pre-HD period, with coronary artery bypass, peripheral vascular surgery, and laparotomies accounting for 32.4%, 16.2%, and 10.8% of procedures, respectively. Nephrectomies and trauma surgery accounted for 8.1% of procedures each, and corrective orthopedic procedures, prostatectomies, and pericardial window operations accounted for 5.4% each.

In the HD period, subjects underwent 40 procedures, of which 22.5% were laparotomies and 15% were for peripheral vascular disease. Trauma surgery, corrective orthopedic procedures, hernia repair, and parathyroidectomy accounted for 10% each, and coronary artery bypass and nephrectomies accounted for 7.5% each.

“Prevention of vascular disease should be a primary concern for patients approaching HD or on HD, particularly if they have diabetes,” the authors concluded.

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