title: The effect of renal dysfunction on short-term outcomes after lumbar fusion.
abstract: OBJECTIVE
  To compare post-lumbar decompression and fusion complication rates and mortality for patients without preoperative hemodialysis (HD) use with and without renal dysfunction as estimated by glomerular filtration rate (GFR) and creatinine levels.
  
  
  METHODS
  Baseline and outcome data were obtained from the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients over the age of 18 who underwent non-emergent lumbar fusion surgery. Preoperative HD status and GFR and creatinine levels were extracted. Variables analyzed included development of at least one complication, development of a major complication, in-hospital mortality, and length of stay.
  
  
  RESULTS
  A total of 29,081 patients were identified. Those with severe preoperative kidney dysfunction as estimated by GFR were more likely to develop a complication (GFR=15-30ml/min/1.73m2; OR, 3.82; 95% CI, 2.061-7.082; P=<0.0001 and GFR=30-45ml/min/1.73m2; OR, 2.124; 95% CI, 1.506-2.996; P<0.0001). Compared to patients with normal preoperative creatinine levels (0.75-1.0mg/dL), patients with elevated creatinine were more likely to develop at least one complication.
  
  
  CONCLUSIONS
  Patients with low estimated GFR and elevated creatinine levels were associated with higher perioperative morbidity. This increased risk should be taken into consideration when counselling this patient population.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Taylor E
authors.initials: TE
authors.lastname: Purvis
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Remi A
authors.initials: RA
authors.lastname: Kessler
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Boone
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: Dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D013123:Spinal Fusion / Q000009:adverse effects / Q000706:statistics & numerical data*
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; Creatinine; Glomerular filtration rate; Hemodialysis; Lumbar fusion; Morbidity; NSQIP; Outcomes