Higher mortality and distinct complications after anterior cervical discectomy and fusion in dialysis patients, despite improvements over prior decade: A national inpatient study
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
ABSTRACT Introduction: Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population. Materials and Methods: The 2016–2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge disposition were compared. Multivariate logistic regression was adjusted for demographic, hospital, and surgical factors. Results: Of 374,975 weighted ACDF admissions, 1155 involved dialysis patients. Dialysis was independently associated with increased odds of cardiovascular complications (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.38–3.07), mechanical complications (OR: 2.67, 95% CI: 1.46–4.90), sepsis (OR: 6.46, 95% CI: 2.98–13.98), nonroutine discharge (OR: 2.02, 95% CI: 1.53–2.68), and inpatient mortality (OR: 8.18, 95% CI: 3.22–20.78). Although absolute inpatient mortality was low in both the groups, it was significantly higher in dialysis patients ( 3 times longer,
Abstract
ABSTRACT Introduction: Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population. Materials and Methods: The 2016–2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge disposition were compared. Multivariate logistic regression was adjusted for demographic, hospital, and surgical factors. Results: Of 374,975 weighted ACDF admissions, 1155 involved dialysis patients. Dialysis was independently associated with increased odds of cardiovascular complications (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.38–3.07), mechanical complications (OR: 2.67, 95% CI: 1.46–4.90), sepsis (OR: 6.46, 95% CI: 2.98–13.98), nonroutine discharge (OR: 2.02, 95% CI: 1.53–2.68), and inpatient mortality (OR: 8.18, 95% CI: 3.22–20.78). Although absolute inpatient mortality was low in both the groups, it was significantly higher in dialysis patients ( 3 times longer, and hospitalization costs were nearly double (< 0.001). Conclusion: Dialysis dependence is associated with distinct complications, substantially prolonged LOS, higher costs, and greater likelihood of nonhome discharge following ACDF. Inhospital mortality remains significantly higher in dialysis patients. Our findings support targeted perioperative optimization and early discharge planning to improve outcomes in this population.