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Mortality and Morbidity in Dialysis-Dependent Patients Undergoing Spinal Surgery

Analysis of a National Administrative Database in Japan

Chikuda, Hirotaka, MD, PhD1; Yasunaga, Hideo, MD, PhD1; Horiguchi, Hiromasa, PhD1; Takeshita, Katsushi, MD, PhD1; Kawaguchi, Hiroshi, MD, PhD1; Matsuda, Shinya, MD, PhD2; Nakamura, Kozo, MD, PhD1

doi: 10.2106/JBJS.K.00183
Scientific Articles
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Background: The impact of dialysis dependence on perioperative risks following spinal surgery is not fully understood. The purposes of the present study were to determine the perioperative risks in dialysis-dependent patients treated with spinal surgery and to examine whether the presence of destructive spondyloarthropathy further increases perioperative risks.

Methods: We examined abstracted data from the Diagnosis Procedure Combination database in a retrospective analysis of a nationally representative inpatient database. The survey of the database is conducted annually for a six-month period between July 1 and December 31. The data from 2007 and 2008 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. For analysis, dialysis-dependent patients were further classified into subgroups with or without destructive spondyloarthropathy.

Results: We identified 51,648 eligible patients (30,743 men and 20,905 women; mean age, sixty-two years), including 869 (1.7%) who were dialysis-dependent. Of the latter, ninety-five had destructive spondyloarthropathy. Overall in-hospital mortality was 0.41%. Dialysis-dependent patients had a significantly higher in-hospital mortality rate than non-dialysis-dependent patients. After adjustment, dialysis-dependent patients remained at a tenfold higher risk for in-hospital death. Dialysis-dependent patients were also at significantly greater risk for postoperative major complications. The rate of complications in dialysis-dependent patients with destructive spondyloarthropathy was 65% higher than that in those without destructive spondyloarthropathy, but this difference did not reach significance.

Conclusions: Dialysis-dependent patients had a tenfold higher risk of in-hospital death than did non-dialysis-dependent patients. Dialysis-dependent patients were also more likely to have major complications such as cardiac events, sepsis, and respiratory complications. Our data also indicate that the presence of destructive spondyloarthropathy is associated with a higher rate of postoperative complications in dialysis-dependent patients.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, Faculty of Medicine (H.C., K.T., H.K., and K.N.), and Department of Health Management and Policy, Graduate School of Medicine (H.Y. and H.H.), The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail address for H. Chikuda: chikuda-tky@umin.ac.jp

2Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan

Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated
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