• Eric Nyam Tee-Tau TT Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan., Sher-Wei Lim, Chung-Han Ho, Jen-Chieh Liao, Jhi-Joung Wang, Chung-Ching Chio, Jinn-Rung Kuo, and Che-Chuan Wang.
• Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
• World Neurosurg. 2019 Feb 1; 122: e667-e675.

BackgroundPatients with end-stage renal disease (ESRD) are at an increased risk of surgical mortality. We aimed to investigate the factors associated with in-hospital mortality in patients with ESRD who underwent spinal surgery, which remains to be determined.Material And MethodsAn age- and sex-matched cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 2000 and December 2012. Kaplan-Meier curves were plotted with log-rank test to compare the differences between these 2 groups. The Cox proportional hazard model was used to estimate the hazard ratio of in-hospital mortality adjusted with potential confounding.ResultsIn total, 4109 participants with pre-existing ESRD and 8218 patients without ESRD were included. The in-hospital mortality in ESRD (10.17%) was greater than without ESRD (1.39%). Spinal surgery patients with pre-existing ESRD had a 6.78-fold increase in-hospital mortality risk compared with those without ESRD. Spinal surgery patients with ESRD of any age, male or female, and comorbidities experienced a greater incidence of hospital mortality. In patients with ESRD, operations on spinal cords and spinal canal structures had the greatest hospital mortality (14.87%) compared with spinal fusion (3.46%) or excision or destruction of intervertebral disc (3.01%). Kaplan-Meier survival curves showed that patients with ESRD experienced greater hospital mortality than patients without ESRD in all 3 spinal surgery methods (log rank P < 0.0001).ConclusionsSpinal surgery patients with ESRD have greater in-hospital mortality than patients without ESRD. Age, sex, history of comorbidities, and types of surgical methods were associated with greater in-hospital mortality among patients with ESRD.Copyright © 2018 Elsevier Inc. All rights reserved.

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