The effect of renal dysfunction on short-term outcomes after lumbar fusion

To compare post-lumbar decompression and fusion complication rates and mortality for patients without preoperative hemodialysis (HD) use with and without renal dysfunction as estimated by glomerular filtration rate (GFR) and creatinine levels.

Baseline and outcome data were obtained from the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients over the age of 18 who underwent non-emergent lumbar fusion surgery. Preoperative HD status and GFR and creatinine levels were extracted. Variables analyzed included development of at least one complication, development of a major complication, in-hospital mortality, and length of stay.

A total of 29,081 patients were identified. Those with severe preoperative kidney dysfunction as estimated by GFR were more likely to develop a complication (GFR=15-30ml/min/1.73m²; OR, 3.82; 95% CI, 2.061-7.082; P=<0.0001 and GFR=30-45ml/min/1.73m²; OR, 2.124; 95% CI, 1.506-2.996; P<0.0001). Compared to patients with normal preoperative creatinine levels (0.75-1.0mg/dL), patients with elevated creatinine were more likely to develop at least one complication.

Patients with low estimated GFR and elevated creatinine levels were associated with higher perioperative morbidity. This increased risk should be taken into consideration when counselling this patient population.