Impact of Dialysis on Complications, Discharge Outcomes, and Healthcare Costs Following Posterior Cervical Fusion Surgery: A National Database Study

Study DesignRetrospective cohort study.ObjectiveDialysis dependent patients have been found to have greater healthcare utilization, rates of postoperative complications, and mortality after cervical spine surgery. However, there is a gap in the literature investigating the impact of dialysis dependency on outcomes after posterior cervical decompression and fusion (PCDF) specifically. To compare perioperative outcomes in dialysis-dependent and non-dialysis-dependent patients after PCDF from 2016 to 2022 using the National Inpatient Sample (NIS) database.MethodsThe NIS was queried for adult patients who were dialysis dependent and underwent PCDF between 2016 and 2022. Data regarding demographics, comorbidities, cost, discharge disposition, hospital characteristics, adverse events, and mortality were collected. Survey-weighted chi-square tests and t-tests were used to compare groups. A multivariable regression was performed to determine whether dialysis dependency was independently predictive of complications, discharge disposition, and inpatient mortality.ResultsOf the 167,995 weighted PCDF admissions identified, 1080 (0.64%) were dialysis dependent. Dialysis patients were more frequently male (66.2% vs 53.0%; <i>P</i> < 0.001), Black (44.4% vs 12.8%; <i>P</i> < 0.001), and from distressed communities. Dialysis dependency was independently associated with increased odds of cardiovascular complications (OR 2.52, 95% CI 1.87-3.41, <i>P</i> < 0.001), sepsis (OR 2.68, 95% CI 1.17-6.15, <i>P</i> = 0.020, and non-routine discharge (OR 1.45, 95% CI 1.05-1.99, <i>P</i> = 0.022). Inpatient mortality was greater in our dialysis dependent cohort (1.9% vs 0.3% <i>P</i> < 0.001).ConclusionDialysis dependency causes increased morbidity, healthcare utilization, and mortality in patients undergoing PCDF. These findings highlight a need for more judicial surgical selection and perioperative management in patients with this comorbidity.Level of EvidenceIII.