Campos Jorge, Bas Jose Luis, Mariscal Gonzalo, Khalil Ibrahim, Alzoubi Mohammad, Bas Paloma, Bas Teresa
La Fe University and Polytechnic Hospital, Valencia, Spain.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Asian Spine J. 2025 Aug;19(4):652-670. doi: 10.31616/asj.2024.0553. Epub 2025 Jul 25.
The purpose of this study was to conduct a systematic review and meta-analysis of the outcomes of spinal surgery in patients with chronic kidney disease (CKD), including those undergoing dialysis. A comprehensive literature search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses were performed using Review Manager software, utilizing mean differences (MD), odds ratios (OR), and random effects models to account for heterogeneity. Heterogeneity was assessed using the I2 statistic. The primary outcomes were operative time, estimated blood loss, need for blood transfusion, length of hospital stay, and the incidence of complications, including deep vein thrombosis (DVT), pulmonary embolism (PE), surgical site infection (SSI), reoperation, and in-hospital mortality. Twelve studies involving over 5 million patients were included, comparing outcomes in CKD and dialysis patients undergoing spinal surgery to those without CKD or dialysis, respectively. CKD patients experienced a significantly shorter operative time (MD, -12.63 minutes; 95% confidence interval [CI], -14.49 to -10.78) and longer hospital stays (MD, 1.51 days; 95% CI, 1.28-1.74), with moderate heterogeneity (I2=37%). Dialysis patients showed higher odds of developing DVT (OR, 6.45; 95% CI, 1.72-24.20), PE (OR, 6.48; 95% CI, 1.13-37.14), and in-hospital mortality (OR, 16.71; 95% CI, 6.23-44.85), with substantial heterogeneity among studies (I2>95%). Additionally, dialysis patients had significantly higher odds of requiring reoperation (OR, 7.04; 95% CI, 2.49-19.86) and longer hospital stays (MD, 5.89 days; 95% CI, 3.58-8.20). CKD and dialysis patients face higher risks following spine surgery compared to their counterparts with normal kidney function. Our study highlights the need for extra care and monitoring of kidney disease patients undergoing spine surgery.
本研究的目的是对慢性肾脏病（CKD）患者，包括接受透析的患者，脊柱手术的结果进行系统评价和荟萃分析。按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行全面的文献检索。使用Review Manager软件进行统计分析，采用平均差（MD）、比值比（OR）和随机效应模型来处理异质性。使用I2统计量评估异质性。主要结局指标为手术时间、估计失血量、输血需求、住院时间以及并发症的发生率，包括深静脉血栓形成（DVT）、肺栓塞（PE）、手术部位感染（SSI）、再次手术和住院死亡率。纳入了12项涉及超过500万患者的研究，分别比较了接受脊柱手术的CKD和透析患者与未患CKD或未接受透析患者的结局。CKD患者的手术时间显著缩短（MD，-12.63分钟；95%置信区间[CI]，-14.49至-10.78），住院时间延长（MD，1.51天；95%CI，1.28 - 1.74），异质性为中度（I2 = 37%）。透析患者发生DVT（OR，6.45；95%CI，1.72 - 24.20）、PE（OR，6.48；95%CI，1.13 - 37.14）和住院死亡率（OR，16.71；95%CI，6.23 - 44.85）的几率更高，研究间存在显著异质性（I2>95%）。此外，透析患者再次手术的几率显著更高（OR，7.04；95%CI，2.49 - 19.86），住院时间更长（MD，5.89天；95%CI，3.58 - 8.20）。与肾功能正常的患者相比，CKD和透析患者脊柱手术后面临更高的风险。我们的研究强调了对接受脊柱手术的肾病患者需要格外护理和监测。
