Inpatient Outcomes in Dialysis-dependent Patients Undergoing Elective Lumbar Surgery for Degenerative Lumbar Disease.

Abstract

Retrospective cohort study. To evaluate hospital outcomes in dialysis-dependent patients undergoing elective lumbar surgeries. Because of their overall poor health status and concomitant comorbidity burden, spinal surgery in dialysis-dependent patients represents a significant challenge to spine surgeons. Large studies evaluating their immediate postoperative outcomes in elective lumbar surgery are lacking. Utilizing the National Inpatient Sample, an estimated 1834 dialysis-dependent patients undergoing elective lumbar spine surgery for degenerative lumbar conditions were compared to an estimated 2,522,594 non-dialysis-dependent patients undergoing the same procedures between 2002 and 2012. Our primary outcomes measures included postoperative complication rates, hospital length of stay, and total hospital costs. Mean age of dialysis-dependent patients was 64.2 years compared to 59.9 in the non-dialysis-dependent cohort (P < 0.001). Dialysis-dependent patients had substantially higher inpatient mortality rates (1.8% vs 0.1%; P < 0.001), major complication rates (8.1% vs 1.1%; P < 0.001), and an increased need for blood transfusion (18.3% vs 12.5%; P < 0.001). Multivariate analysis revealed that dialysis dependence independently increased odds of in-hospital mortality (odds ratio = 8.30; 95% confidence interval 5.78-11.93; P < 0.001) and odds of a major postoperative complication (odds ratio = 3.63; 95% confidence interval 3.49-3.89; P < 0.001). Dialysis dependence was associated with an increased mean length of stay of 3.3 days (P < 0.001) and a significant increase in hospital costs when stratified by procedure type. Dialysis dependence is associated with poorer immediate postoperative outcomes and increased hospital costs when compared to non-dialysis-dependent patients. In addition, an increased need for postoperative transfusion should be anticipated in this patient population. Further studies are warranted to confirm these findings. 3.