Reoperation after short-segment lumbar spinal fusion surgery in dialysis patients: A retrospective cohort study.

Abstract

Patients with dialysis are at high risk of reoperation after lumbar spinal fusion surgery. However, the risk of reoperation after short-segment (≤2 fusion levels) lumbar spinal fusion surgery in this patient group has not been completely investigated. This study aimed to compare the risk of reoperation after short-segment lumbar spinal fusion surgery between patients with dialysis and matched controls without dialysis. We retrospectively evaluated 85 patients who underwent short-segment lumbar spinal fusion surgery at a single institution. Based on the current dialysis treatment, patients were divided into the non-dialysis and dialysis groups. We compared the patients' characteristics, surgical data, pre- and postoperative radiographic measurements, locomotive functional levels in activities of daily living (ADL), rate of whole reoperation, and cause-specific incidence of reoperation such as adjacent segmental disease (ASD) and implant failure between the non-dialysis and dialysis groups. Then, these variables were compared after adjusting for age, sex, and body mass index (BMI) via a propensity-score-matched analysis. In total, 68 patients in the non-dialysis group and 17 patients in the dialysis group were included in this study. The dialysis group was significantly younger and had a lower postoperative ADL status than the non-dialysis group. Moreover, the dialysis group had a significantly higher rate of whole reoperation (8.8% vs 41.2%, P = .003), reoperation due to ASD (4.4% vs 23.5%, P = .027), and reoperation due to implant failure (0.8% vs 11.8%, P = .038) than in the non-dialysis group. Based on a propensity-score-matched analysis, the dialysis group had a significantly higher rate reoperation rate after short-segment lumbar spinal fusion surgery than the non-dialysis group (0.0% vs 58.3%, P = .005). The current study firstly clarified that patients with dialysis are at significantly high risk of reoperation even after short-segment lumbar spinal fusion surgery.