Postoperative Complications and Survival Rate in Hemodialysis-Dependent Patients Undergoing Cervical Spine Surgery

Abstract

Introduction Spine surgery is challenging in hemodialysis (HD)-dependent patients owing to their poor general condition. However, postoperative complications and the mortality and survival rates have not been specifically evaluated in a wide series. This study aimed to elucidate postoperative complications and the survival rate in cervical spine surgery in HD patients. Methods This study included 109 HD patients (70 men, 39 women) who had undergone cervical spine surgery between July 1996 and May 2018. Based on radiological diagnosis, we divided them into the destructive spondyloarthropathy (DSA) and non-DSA groups. We investigated the causes of hemodialysis, postoperative complications, postoperative inpatient mortality rate, and survival rate. Results The DSA and non-DSA groups included 100 surgeries in 89 patients and 21 surgeries in 20 patients, respectively. The mean age at surgery was 62.9 years for the DSA and 55.9 years for the non-DSA group (P=0.97). The DSA group had a shorter hemodialysis period at surgery compared with the non-DSA group (21.7 vs. 26.5 years, P<0.05). The two most common causes of HD in both groups were chronic glomerulonephritis (DSA, 45%; non-DSA, 57.1%) and diabetes (DSA, 11%; non-DSA, 14.5%). Postoperative complications were observed in 23% (23/100) and 19% (4/21) of surgeries in the DSA and non-DSA groups, respectively (P=0.782). The total in-hospital mortality rate was 2.5% (3/121). The 1-, 3-, 5-, and 10-year postoperative survival rates of all patients were 89.6%, 75.5%, 67.1%, and 44.7%, respectively. The survival rates did not depend on the group (DSA vs. non-DSA), pre- and postoperative Japanese Orthopedic Association score for cervical myelopathy, hemodialysis period, sex, and age (P>0.05). However, significantly low survival rates were observed in HD caused by diabetes compared with that by chronic glomerulonephritis (P<0.001) and other causes (P<0.001). Conclusions Cervical spine surgery in HD patients is associated with postoperative complications. The postoperative survival rate was found to be low if the cause of hemodialysis was diabetes.

The significance of metabolic disease in degenerative cervical myelopathy: a systematic review

“…Identification of confounding factors (e.g., sex, age and duration of symptoms) was mostly adequate, except in six studies that appeared to miss key confounders ( 47 , 52 , 56 , 58 , 60 , 61 ), most commonly due to lack of complete exclusion criteria, and two studies that appeared to be missing most confounders ( 32 , 49 ). Strategies to deal with confounders was performed to a lower quality, with 13 studies deemed unclear ( 38 , 39 , 50 , 52 , 53 , 55 , 58 , 60 , 61 , 66 , 73 , 77 , 79 ), and four studies deemed inadequate ( 32 , 47 , 48 , 56 ), most commonly due to a lack of a multivariate regression analysis. The cohorts were deemed either free of the outcome at the start of all studies or this criteria was not applicable, if for example the outcome was improvement in neurological status.…”

“…The outcomes were measured in a valid and reliable manner in most studies, except one ( 49 ), where the methods section was sparse. The follow-up time was mostly adequate in length and reporting, except in nine studies ( 34 , 44 , 47 , 49 , 55 , 58 , 61 , 73 , 86 ), often due to incomplete reporting. Follow-up was mostly adequate, often owing to the retrospective nature of a significant portion of included studies, or if there was substantial loss to follow-up, this was usually reasonably explored, except in two studies ( 46 , 66 ).…”