"Lumbar Degenerative Surgery in Dialysis-Dependent Patients: Complications and Patient-Reported Outcomes".

Abstract

Outcomes of lumbar spine surgery in dialysis-dependent patients remain poorly characterized, particularly regarding patient-reported outcome measures (PROMs). To evaluate PROMs and complications in dialysis-dependent patients undergoing lumbar degenerative surgery. Multicenter retrospective cohort study. We analyzed 19,911 patients, including 361 dialysis-dependent and 19,550 non-dialysis-dependent patients, who underwent elective lumbar degenerative surgery between 2017 and 2023. Outcomes included 1-year changes in Numeric Rating Scale (NRS) for pain, EuroQol 5-Dimension (EQ-5D), and Oswestry Disability Index (ODI), as well as patient satisfaction at 1 year, and perioperative complications and reoperations within 30 days. Outcomes were compared between dialysis-dependent and non-dialysis-dependent patients. Propensity score matching was performed to adjust for baseline characteristics. Non-inferiority of improvements in PROMs (NRS for pain, EQ-5D, ODI) was tested with predefined non-inferiority margins (Δ = 1.5, -0.2, 15, respectively). In the overall cohort, the dialysis-dependent group was older, had a lower BMI, had higher American Society of Anesthesiologists Physical Status (ASA-PS) classes, and had a higher prevalence of comorbidities. They also underwent more extensive surgeries, with higher complication and reoperation rates and worse PROMs compared with the non-dialysis-dependent group. The non-dialysis-dependent group demonstrated a significantly greater improvement in EQ-5D (0.20 vs 0.17; p = 0.03) and a higher satisfaction rate (83% vs 74%; p = 0.004) than the dialysis-dependent group. However, both groups showed significant postoperative improvements in PROMs. Notably, 74% of the dialysis-dependent patients were satisfied with their surgery. In the matched cohort, despite baseline and postoperative PROMs were worse in dialysis-dependent group, improvements in PROMs were non-inferior to those in the non-dialysis-dependent patients. These findings were consistent in multivariable and sensitivity analyses. Despite poorer baseline characteristics and higher complication rates, dialysis-dependent patients achieved significant and non-inferior improvements in PROMs and satisfaction after lumbar spine surgery. These findings support lumbar spine surgery as a feasible treatment option for appropriately selected dialysis-dependent patients.