Impact of Renal Osteodystrophy on In-Hospital Outcomes Following Cervical Fusion: A National Inpatient Sample Study.

Abstract

Study DesignRetrospective cross-sectional study.ObjectivesTo evaluate the association between renal osteodystrophy (ROD) and in-hospital outcomes following cervical fusion.MethodsWe performed a retrospective analysis of the National Inpatient Sample from 2016 to 2022. Adult patients undergoing cervical fusion were identified and categorized according to the presence or absence of ROD. Propensity score matching was used to balance baseline demographic, hospital, and comorbidity characteristics. Multivariable logistic regression was applied to assess in-hospital complications, and resource utilization was evaluated using length of stay and total hospital charges. A CKD-only sensitivity analysis was additionally performed by comparing patients with ROD and concomitant CKD codes against patients with CKD codes but without ROD.ResultsAfter matching, 576 ROD and 2,403 non-ROD patients were included. ROD was associated with higher risks of mechanical ventilation (OR 1.429, 95% CI 1.033-1.952), delirium (OR 2.043, 95% CI 1.197-3.386), thrombocytopenia (OR 1.585, 95% CI 1.148-2.163), and transfusion (OR 1.700, 95% CI 1.282-2.236) (all p < 0.05). ROD patients also had a longer length of stay (9 vs 5 days) and higher total hospital charges ($168,428 vs $133,017) (both p < 0.001). In the CKD-only sensitivity analysis, elevated risks persisted for delirium, transfusion, and thrombocytopenia, whereas the mechanical ventilation signal was attenuated.ConclusionsROD was associated with a higher burden of perioperative in-hospital complications and greater hospital resource utilization following cervical fusion. These findings suggest that patients with ROD may benefit from closer perioperative risk stratification and multidisciplinary monitoring, particularly with respect to bleeding risk and delirium prevention.