Hendrix Christopher G, Goheer Haseeb E, Newcomb Alden H, Carmouche Jonathan J
Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, VA 24014, United States.
Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States.
N Am Spine Soc J. 2024 May 24;19:100331. doi: 10.1016/j.xnsj.2024.100331. eCollection 2024 Sep.
Although anterior cervical discectomy and fusion (ACDF) procedures for cervical spine disease have been increasing amid a growing population of patients with kidney dysfunction, there is a scarcity of literature focusing on kidney dysfunction as a risk-factor for post-operative ACDF complications. The purpose is to evaluate the differential impact of kidney dysfunction on perioperative outcomes including surgical and medical complications, extended length of hospital stay (LOS), and death within 30 days following ACDF.
This was a retrospective cohort study of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who had undergone an elective ACDF procedure between 2011-2021 using Current Procedural Terminology code 22551. Patients were categorized into five cohorts based on eGFR according to the "Kidney Disease: Improving Global Outcomes" Classification: values of: ≥ 90(reference cohort), 60-89 (G2), 30-59 (G3), 15-29 (G4), and <15 (G5). One-way ANOVA for continuous variables and chi-square tests for categorical variables were used to identify differences in perioperative variables between the five groups. Multivariable logistic regression analysis assessed the effect of kidney dysfunction on post-operative surgical outcomes. Significance was defined as p<.05.
About 75,508 ACDF patients were included, of who 57,480 were G1, 15,186 were G2, 2,192 were G3, 312 were G4, and 338 were G5. G4 and G5 independently increased the risk of medical complications (OR: 1.893, 95% CI [1.296-2.705]; OR: 2.241, 95% CI [1.222-3.964]) and blood transfusion. Only G5 independently increased the risk for extended LOS (OR: 2.410, 95% CI [1.281-4.371], p=.005).
High grade CKD is an independent risk factor for medical complications, extended hospital LOS, and blood transfusions following ACDF, underscoring the importance of risk stratification to optimize perioperative management and reduce the burden of complications and healthcare costs. Conversely, low grade CKD does not increase the risk of complications in ACDF.
尽管随着肾功能不全患者数量的增加，颈椎前路椎间盘切除融合术（ACDF）治疗颈椎疾病的手术量一直在上升，但关注肾功能不全作为ACDF术后并发症危险因素的文献却很少。本研究旨在评估肾功能不全对围手术期结局的不同影响，包括手术和医疗并发症、延长的住院时间（LOS）以及ACDF术后30天内的死亡情况。
这是一项回顾性队列研究，使用美国外科医师学会国家外科质量改进计划数据库对前瞻性收集的数据进行分析，以识别2011年至2021年间使用当前手术操作术语代码22551接受择期ACDF手术的患者。根据“改善全球肾脏病预后”分类，根据估算肾小球滤过率（eGFR）将患者分为五个队列：eGFR值≥90（参照队列）、60 - 89（G2）、30 - 59（G3）、15 - 29（G4）和<15（G5）。对连续变量采用单因素方差分析，对分类变量采用卡方检验，以确定五组之间围手术期变量的差异。多变量逻辑回归分析评估肾功能不全对术后手术结局的影响。显著性定义为p<0.05。
共纳入约75508例ACDF患者，其中57480例为G1，15186例为G2，2192例为G3，312例为G4，338例为G5。G4和G5独立增加了医疗并发症风险（比值比：1.893，95%置信区间[1.296 - 2.705]；比值比：2.241，95%置信区间[1.222 - 3.964]）和输血风险。只有G5独立增加了延长住院时间的风险（比值比：2.410，95%置信区间[1.281 - 4.371]，p = 0.005）。
重度慢性肾脏病是ACDF术后发生医疗并发症、延长住院时间和输血的独立危险因素，强调了风险分层对于优化围手术期管理、减轻并发症负担和降低医疗成本的重要性。相反，轻度慢性肾脏病不会增加ACDF术后并发症的风险。
