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Purpose <p>The purpose of this study was to compare perioperative outcomes between dialysis-dependent and non-dialysis patients undergoing multilevel lumbar fusion.</p> Methods <p>The National Inpatient Sample (2016–2022) was queried for adults undergoing elective multilevel lumbar fusion. Dialysis dependence was identified using ICD-10-CM codes. Demographic, clinical, and hospital characteristics were compared between groups using survey-weighted analyses. Multivariable logistic regression examined the independent association between dialysis status and complications, non-routine discharge, and inpatient mortality. Significance was set at the <i>P</i> &lt; 0.05 level.</p> Results <p>Among 459,360 weighted admissions, 840 (0.18%) were dialysis-dependent. This cohort had a higher comorbidity burden (mean Elixhauser Index 4.33 versus 2.33; <i>P</i> &lt; 0.001), was more often male, Black, and from lower-income areas. After adjustment, dialysis dependence was associated with increased odds of cardiovascular complications (OR 1.48; 95% CI 1.08–2.04), sepsis (OR 3.24; 95% CI 1.53–6.88), any adverse event (OR 1.59; 95% CI 1.16–2.18), non-routine discharge (OR 1.84; 95% CI 1.26–2.70), and inpatient mortality (OR 7.21; 95% CI 3.02–17.23). Mean hospital costs ($73,711 vs. $53,676; <i>P</i> = 0.003) and length of stay (9.76 vs. 4.41 days; <i>P</i> &lt; 0.001) were higher in dialysis patients.</p> Conclusions <p>Dialysis-dependent patients undergoing multilevel lumbar fusion experience higher morbidity, prolonged hospitalization, and greater costs. While their odds of inpatient death are higher, absolute mortality in both groups was low. These findings underscore the need for targeted perioperative optimization and discharge planning in this high-risk group.</p>

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Dialysis status and its association with complications, discharge outcomes, and costs after multilevel lumbar fusion: a national analysis

  • 期刊论文

  • 发表日期：

    2026年4月25日

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  • Mitchell K. Ng,
  • Leonidas E. Mastrokostas,
  • Paul G. Mastrokostas,
  • Gregorio Baek,
  • Jonathan Dalton,
  • Morgan Hitchner,
  • William A. Green,
  • Joshua Mathew,
  • Yasmine Eichbaum,
  • Yulia Lee,
  • Adam Fano,
  • Alec Giakas,
  • Rajendra Singh,
  • Pemla Jagtiani,
  • Jad Bou Monsef,
  • Afshin E. Razi,
  • Daniel R. Fassett,
  • Alan S. Hilibrand,
  • Alexander R. Vaccaro,
  • Gregory D. Schroeder,
  • Christopher K. Kepler,
  • Andrew P. Alvarez

摘要

Purpose

The purpose of this study was to compare perioperative outcomes between dialysis-dependent and non-dialysis patients undergoing multilevel lumbar fusion.

Methods

The National Inpatient Sample (2016–2022) was queried for adults undergoing elective multilevel lumbar fusion. Dialysis dependence was identified using ICD-10-CM codes. Demographic, clinical, and hospital characteristics were compared between groups using survey-weighted analyses. Multivariable logistic regression examined the independent association between dialysis status and complications, non-routine discharge, and inpatient mortality. Significance was set at the P < 0.05 level.

Results

Among 459,360 weighted admissions, 840 (0.18%) were dialysis-dependent. This cohort had a higher comorbidity burden (mean Elixhauser Index 4.33 versus 2.33; P < 0.001), was more often male, Black, and from lower-income areas. After adjustment, dialysis dependence was associated with increased odds of cardiovascular complications (OR 1.48; 95% CI 1.08–2.04), sepsis (OR 3.24; 95% CI 1.53–6.88), any adverse event (OR 1.59; 95% CI 1.16–2.18), non-routine discharge (OR 1.84; 95% CI 1.26–2.70), and inpatient mortality (OR 7.21; 95% CI 3.02–17.23). Mean hospital costs ($73,711 vs. $53,676; P = 0.003) and length of stay (9.76 vs. 4.41 days; P < 0.001) were higher in dialysis patients.

Conclusions

Dialysis-dependent patients undergoing multilevel lumbar fusion experience higher morbidity, prolonged hospitalization, and greater costs. While their odds of inpatient death are higher, absolute mortality in both groups was low. These findings underscore the need for targeted perioperative optimization and discharge planning in this high-risk group.