Postoperative Complications in Dialysis-Dependent Patients Undergoing Elective Decompression Surgery Without Fusion or Instrumentation for Degenerative Cervical or Lumbar Lesions

Study Design: This was a single-institute retrospective study.

Objective: To evaluate postoperative complications in dialysis-dependent patients undergoing elective cervical and lumbar decompression surgery.

Summary Of Background Data: Spinal surgery in dialysis-dependent patients is very challenging due to the high risk of serious postoperative complications and mortality associated with their fragile general condition. However, the outcome of decompression surgery alone has not been evaluated in such patients.

Methods: An electronic medical record review showed that 338 and 615 patients had undergone cervical and lumbar spine posterior decompression, respectively. Among them, 48 and 42, respectively were dialysis-dependent patients. Postoperative complications were compared between dialysis-dependent and non-dialysis-dependent patients.

Results: Among patients who underwent cervical decompression, the rate of perioperative blood transfusion in dialysis-dependent patients (14.6%) was significantly higher than that in non-dialysis-dependent patients (0.7%). No severe complications or mortality occurred in association with cervical decompression. The incidence of postoperative complications in dialysis-dependent patients (6.3%) was not significantly different from that in non-dialysis-dependent patients (4.1%). Among patients who underwent lumbar decompression, the rate of perioperative transfusion in dialysis-dependent patients (11.9%) was also significantly higher than that in non-dialysis-dependent patients (0.7%). With respect to severe complications among patients who underwent lumbar decompression, cerebral hemorrhage occurred in one dialysis-dependent patient, and no mortality occurred. The incidence of postoperative complications in dialysis-dependent patients (9.2%) was not significantly different from that in non-dialysis-dependent patients (6.8%).

Conclusion: Among patients who underwent posterior decompression alone for cervical or lumbar lesions, the rate of perioperative blood transfusion was significantly higher in dialysis-dependent than in non-dialysis-dependent patients. However, the postoperative rates of severe complications and mortality were not significantly different between the two groups. Therefore, decompression surgery alone is considered a rational surgical method with less invasiveness for dialysis-dependent patients with a fragile general condition.

Level Of Evidence: 3.