Aim: We aimed to study the impact of major surgical procedures on clinical outcome in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or peritoneal dialysis (PD).Methods: We retrospectively evaluated chart records of all patients on HD and PD who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical procedures were recorded.Results: Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. Forty-seven patients (23%) had a major surgical operation. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study population, 59 patients (29%) died during the study period. The mortality rate was higher in patients who experienced postoperative complications (P < .001). Kaplan–Meier analysis revealed that mean (95% CI) survival time in operated patients was 43 months (37-49 months), while it was 49 months (46-52 months) in the others (P=.023). Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, P=.005), diabetes (RR 2.581, 95% CI 1.474-4.521, P=.001), pre-operative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, P < .0001) and undergoing a major surgical procedure (RR 1.868, 95% CI 1.068-3.268, P=.028) were independent predictors of mortality.Conclusion: Our study shows that, in addition to age, diabetes, and inflammatory status, undergoing a major surgical procedure is an independent risk factor for mortality in dialysis patients. Proper management of perioperative complications may result in more favorable outcomes in these patients.