title: Postoperative Morbidity and Mortality After Elective Anterior Cervical Fusion in Patients with Chronic and End-Stage Renal Disease.
abstract: OBJECTIVE
  We sought to investigate the postoperative morbidity and mortality rate of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing elective anterior cervical fusion (ACF).
  
  
  METHODS
  The Nationwide Inpatient Sample database from 2002-2011 was used to identify adult patients who underwent elective ACF for degenerative spine disease. Major complication rates and in-hospital mortality were compared among 3 groups-no kidney disease, CKD, and ESRD (dialysis dependent). A multiple logistic regression analysis was conducted to assess the independent effect of CKD and ESRD on outcome.
  
  
  RESULTS
  There were 164,097 patients who met inclusion criteria. Among these, 1047 had CKD (0.64%) and 270 had ESRD (0.16%). After multiple logistic regression analysis, patients with CKD (odds ratio [OR] 1.51; 95% confidence interval [CI], 1.13-2.01; P = 0.005) and ESRD (OR 1.96; 95% CI, 1.20-3.21; P = 0.007) were significantly more likely to incur a postoperative complication when compared with patients without kidney disease (the reference group). Compared with patients without kidney disease, patients with CKD did not have higher odds of postoperative mortality (OR 2.25; 95% CI, 0.83-6.06; P = 0.108). However, in-hospital mortality was 15 times higher for patients with ESRD compared with patients without kidney disease (OR 15.2; 95% CI, 5.67-40.88; P < 0.001).
  
  
  CONCLUSIONS
  Chronic and end-stage renal disease may significantly increase the risk of postoperative morbidity and mortality after ACF. Future research into preoperative optimization of these patients and on the potential benefits of undergoing surgery until after renal transplantation is warranted.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nakhla
authors.affiliation: Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Rani
authors.initials: R
authors.lastname: Nasser
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Puvanesarajah
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.affiliation: Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Yassari
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion; D014481:United States / Q000453:epidemiology
keywords: Anterior cervical fusion; Chronic kidney disease; Complications; Dialysis; End-stage renal failure; Mortality; Nationwide inpatient sample