The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion

Jonathan Nakhla, Rafael de la Garza Ramos, Niketh Bhashyam, Andrew Kobets, Rani Nasser, Murray Echt, Gernot Lang, Rodrigo Navarro-Ramirez, Ajit Jada, Merritt D. Kinon, Reza Yassari

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1 Scopus citations

Abstract

Background Kidney disease in spine surgery can be associated with serious complications. Objective To investigate the rate of acute tubular necrosis (ATN) and surgical site infection (SSI) after lumbar fusion in patients with kidney disease. Methods A review of the U.S. Nationwide Inpatient Sample from 2002 to 2011 was performed to identify patients who underwent lumbar fusion for degenerative spine disease or disk herniation. Four groups were established: no kidney disease, chronic kidney disease (CKD), end-stage renal disease (ESRD), and posttransplant. A multivariate analysis was performed to control for age, sex, and comorbidities. Results A total of 268,158 patients met the criteria; 263,757 with no kidney disease (98.4%), 3576 with CKD (1.3%), 586 with ESRD (0.2%), and 239 posttransplant (0.1%). Rates of ATN were 0.1%, 2.9%, 3.6%, and 0.0% for the 4 groups, respectively (P < 0.001). Rates of SSI were 0.3%, 0.4%, 1.0%, and 0.0%, respectively (P = 0.002). After controlling for patient age, sex, and medical comorbidities, patients with CKD (odds ratio [OR], 5.42; 95% confidence interval [CI], 4.14–7.09; P < 0.001) and ESRD (OR, 6.32; 95% CI, 3.89–10.33; P < 0.001) were significantly more likely to develop ATN compared with patients without kidney disease. However, CKD (OR, 0.80; 95% CI, 0.20–3.12; P = 0.754) or ESRD (OR, 1.96; 95% CI, 0.38–10.00; P = 0.415) did not increase the risk for SSI on multivariate analysis. Discussion The rate of ATN significantly increases based on severity of kidney disease. However, patients with transplants have ATN and SSI rates comparable with patients without kidney disease.

Original languageEnglish (US)
Pages (from-to)498-502
Number of pages5
JournalWorld Neurosurgery
Volume105
DOIs
StatePublished - Sep 1 2017

Keywords

  • Acute tubular necrosis
  • Chronic kidney disease
  • End-stage renal disease
  • Renal transplant
  • Spinal lumbar fusion
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Nakhla, J., de la Garza Ramos, R., Bhashyam, N., Kobets, A., Nasser, R., Echt, M., Lang, G., Navarro-Ramirez, R., Jada, A., Kinon, M. D., & Yassari, R. (2017). The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion. World Neurosurgery, 105, 498-502. https://doi.org/10.1016/j.wneu.2017.05.088