Abstract
Background
Because of the high incidence of major perioperative adverse events, spine surgery
in dialysis patients should be recommended carefully after consideration of its risks
and benefits. However, the benefits of spine surgery in dialysis patients remain unclear
because of the lack of long-term outcomes. The purpose of this study is to elucidate
the long-term outcomes of spine surgery in dialysis patients, focusing on activities
of daily living (ADLs), life expectancy, and risk factors for postoperative mortality.
Methods
Data for 65 dialysis patients who underwent spine surgery at our institution and were
followed up for a mean duration of 6.2 years were retrospectively reviewed. ADLs,
number of surgeries, and survival times were recorded. The postoperative survival
rate was calculated using the Kaplan-Meier method, and risk factors for postoperative
mortality were investigated using a generalized Wilcoxon test and multivariate Cox
proportional-hazards model.
Results
Compared with preoperative ADLs, ADLs significantly improved at discharge after surgery
and at the final follow-up. However, 16 of the 65 patients (24.6%) underwent multiple
surgeries, and 34 (52.3%) died during the follow-up period. Kaplan-Meier analysis
revealed that the survival rate after spine surgery was 95.4% at 1 year, 86.2% at
3 years, 69.6% at 5 years, 59.7% at 7 years, and 28.7% at 10 years, and the overall
median survival time was 99 months. Multivariate Cox regression analysis showed that
a dialysis period of ≥10 years was a significant risk factor.
Conclusions
Spine surgery in dialysis patients improved and maintained ADLs in the long term and
did not shorten life expectancy. However, dialysis patients undergoing spine surgery
require multiple surgeries more frequently, and a dialysis period of ≥10 years is
a significant risk factor for postoperative mortality.
Keywords
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Article info
Publication history
Published online: March 07, 2023
Accepted:
February 21,
2023
Received in revised form:
February 14,
2023
Received:
November 9,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
