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

Research output: Contribution to journalArticle

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

Fingerprint

Surgical Wound Infection
Kidney Diseases
Necrosis
Chronic Renal Insufficiency
Chronic Kidney Failure
Odds Ratio
Confidence Intervals
Comorbidity
Spine
Multivariate Analysis
Inpatients
Transplants

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

Cite this

The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion. / Nakhla, Jonathan; de la Garza Ramos, Rafael; Bhashyam, Niketh; Kobets, Andrew; Nasser, Rani; Echt, Murray; Lang, Gernot; Navarro-Ramirez, Rodrigo; Jada, Ajit; Kinon, Merritt D.; Yassari, Reza.

In: World Neurosurgery, Vol. 105, 01.09.2017, p. 498-502.

Research output: Contribution to journalArticle

Nakhla, J, de la Garza Ramos, R, Bhashyam, N, Kobets, A, Nasser, R, Echt, M, Lang, G, Navarro-Ramirez, R, Jada, A, Kinon, MD & Yassari, R 2017, 'The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion', World Neurosurgery, vol. 105, pp. 498-502. https://doi.org/10.1016/j.wneu.2017.05.088
Nakhla, Jonathan ; de la Garza Ramos, Rafael ; Bhashyam, Niketh ; Kobets, Andrew ; Nasser, Rani ; Echt, Murray ; Lang, Gernot ; Navarro-Ramirez, Rodrigo ; Jada, Ajit ; Kinon, Merritt D. ; Yassari, Reza. / The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion. In: World Neurosurgery. 2017 ; Vol. 105. pp. 498-502.
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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.",
keywords = "Acute tubular necrosis, Chronic kidney disease, End-stage renal disease, Renal transplant, Spinal lumbar fusion, Surgical site infection",
author = "Jonathan Nakhla and {de la Garza Ramos}, Rafael and Niketh Bhashyam and Andrew Kobets and Rani Nasser and Murray Echt and Gernot Lang and Rodrigo Navarro-Ramirez and Ajit Jada and Kinon, {Merritt D.} and Reza Yassari",
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AU - Bhashyam, Niketh

AU - Kobets, Andrew

AU - Nasser, Rani

AU - Echt, Murray

AU - Lang, Gernot

AU - Navarro-Ramirez, Rodrigo

AU - Jada, Ajit

AU - Kinon, Merritt D.

AU - Yassari, Reza

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N2 - 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.

AB - 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.

KW - Acute tubular necrosis

KW - Chronic kidney disease

KW - End-stage renal disease

KW - Renal transplant

KW - Spinal lumbar fusion

KW - Surgical site infection

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