title: Inpatient Outcomes in Dialysis-dependent Patients Undergoing Elective Lumbar Surgery for Degenerative Lumbar Disease.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To evaluate hospital outcomes in dialysis-dependent patients undergoing elective lumbar surgeries.
  
  
  BACKGROUND
  Because of their overall poor health status and concomitant comorbidity burden, spinal surgery in dialysis-dependent patients represents a significant challenge to spine surgeons. Large studies evaluating their immediate postoperative outcomes in elective lumbar surgery are lacking.
  
  
  METHODS
  Utilizing the National Inpatient Sample, an estimated 1834 dialysis-dependent patients undergoing elective lumbar spine surgery for degenerative lumbar conditions were compared to an estimated 2,522,594 non-dialysis-dependent patients undergoing the same procedures between 2002 and 2012. Our primary outcomes measures included postoperative complication rates, hospital length of stay, and total hospital costs.
  
  
  RESULTS
  Mean age of dialysis-dependent patients was 64.2 years compared to 59.9 in the non-dialysis-dependent cohort (P < 0.001). Dialysis-dependent patients had substantially higher inpatient mortality rates (1.8% vs 0.1%; P < 0.001), major complication rates (8.1% vs 1.1%; P < 0.001), and an increased need for blood transfusion (18.3% vs 12.5%; P < 0.001). Multivariate analysis revealed that dialysis dependence independently increased odds of in-hospital mortality (odds ratio = 8.30; 95% confidence interval 5.78-11.93; P < 0.001) and odds of a major postoperative complication (odds ratio = 3.63; 95% confidence interval 3.49-3.89; P < 0.001). Dialysis dependence was associated with an increased mean length of stay of 3.3 days (P < 0.001) and a significant increase in hospital costs when stratified by procedure type.
  
  
  CONCLUSIONS
  Dialysis dependence is associated with poorer immediate postoperative outcomes and increased hospital costs when compared to non-dialysis-dependent patients. In addition, an increased need for postoperative transfusion should be anticipated in this patient population. Further studies are warranted to confirm these findings.
  
  
  METHODS
  3.
authors.affiliation: Orthopedic Surgery Residency, University of Arizona College of Medicine - Phoenix, Phoenix.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Chung
authors.affiliation: Orthopedic Surgery Residency, University of Arizona College of Medicine - Phoenix, Phoenix.
authors.forename: David H
authors.initials: DH
authors.lastname: Campbell
authors.affiliation: Orthopedic Surgery Residency, University of Arizona College of Medicine - Phoenix, Phoenix.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Hustedt
authors.affiliation: Center for Orthopedic Research and Education, Phoenix, AZ.
authors.forename: Neil
authors.initials: N
authors.lastname: Olmscheid
authors.affiliation: Orthopedic Surgery Residency, University of Arizona College of Medicine - Phoenix, Phoenix.|Center for Orthopedic Research and Education, Phoenix, AZ.
authors.forename: Norman
authors.initials: N
authors.lastname: Chutkan
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000401:mortality / Q000639:trends; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D005260:Female; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality / Q000639:trends; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D016896:Treatment Outcome