The Impact of Dialysis on Postoperative Outcomes in Patients With Chronic Kidney Disease Undergoing Thoracolumbar Trauma Repair

Study Design: Retrospective cohort study. Objective: To evaluate perioperative complications in chronic kidney disease (CKD) patients on dialysis undergoing thoracolumbar (TL) trauma surgery. Summary of Background Data: TL trauma in the elderly population is associated with significant morbidity and mortality. Chronic kidney disease (CKD), particularly end-stage renal disease (ESRD) requiring dialysis, is specifically relevant due to the impact of renal osteodystrophy and systemic illness. Despite extensive research on TL trauma, the impact of chronic dialysis on postoperative outcomes remains poorly understood. Materials and Methods: A retrospective analysis was conducted using the PearlDiver database to identify patients with stage III to V CKD who underwent surgical TL trauma repair within 30 days of admission from 2010 to 2022. Two separate cohorts were created based on the use of dialysis within 6 months before surgery. Outcomes analyzed included 90-day medical complications, health care utilization, and two-year surgical complications. Univariate statistical analysis was performed, followed by multivariable logistic regression controlling for demographic variables and pertinent comorbidities. Results: Dialysis patients exhibited increased risks of increased rate of myocardial infarction (7.3% vs. 3.9%; OR: 1.80; P <0.001), cardiac arrest (5.1% vs. 1.7%; OR: 2.31; P <0.001), respiratory failure (18.2% vs. 11.1%; OR: 1.38; P <0.001), pleural effusion (21.6% vs. 11.4%; OR: 1.45; P <0.001), electrolyte abnormality (19.6% vs. 12.4%; OR: 1.60; P <0.001), pneumonia (22.9% vs. 13.1%; OR: 1.20; P =0.005), sepsis (10.7% vs. 4.1%; OR: 1.72; P <0.001), and spine infection (16.7% vs. 3.5%; OR: 2.67; P <0.001). Emergency department visits at three months were significantly higher in dialysis patients when compared with CKD controls not on dialysis (32.4% vs. 25.6%; OR: 1.31; P <0.001). Conclusions: Dialysis dependence significantly increases postoperative morbidity following TL trauma repair. These results highlight the need for multidisciplinary care to mitigate risks and optimize outcomes in this vulnerable population. Future research may focus on the impact of the timing of dialysis on perioperative outcomes.