Dialysis status and its association with complications, discharge outcomes, and costs after multilevel lumbar fusion: a national analysis.
Publication/Presentation Date
4-25-2026
Abstract
PURPOSE: The purpose of this study was to compare perioperative outcomes between dialysis-dependent and non-dialysis patients undergoing multilevel lumbar fusion. METHODS: The National Inpatient Sample (2016–2022) was queried for adults undergoing elective multilevel lumbar fusion. Dialysis dependence was identified using ICD-10-CM codes. Demographic, clinical, and hospital characteristics were compared between groups using survey-weighted analyses. Multivariable logistic regression examined the independent association between dialysis status and complications, non-routine discharge, and inpatient mortality. Significance was set at the P < 0.05 level. RESULTS: Among 459,360 weighted admissions, 840 (0.18%) were dialysis-dependent. This cohort had a higher comorbidity burden (mean Elixhauser Index 4.33 versus 2.33; P < 0.001), was more often male, Black, and from lower-income areas. After adjustment, dialysis dependence was associated with increased odds of cardiovascular complications (OR 1.48; 95% CI 1.08–2.04), sepsis (OR 3.24; 95% CI 1.53–6.88), any adverse event (OR 1.59; 95% CI 1.16–2.18), non-routine discharge (OR 1.84; 95% CI 1.26–2.70), and inpatient mortality (OR 7.21; 95% CI 3.02–17.23). Mean hospital costs ($73,711 vs. $53,676; P = 0.003) and length of stay (9.76 vs. 4.41 days; P < 0.001) were higher in dialysis patients. CONCLUSIONS: Dialysis-dependent patients undergoing multilevel lumbar fusion experience higher morbidity, prolonged hospitalization, and greater costs. While their odds of inpatient death are higher, absolute mortality in both groups was low. These findings underscore the need for targeted perioperative optimization and discharge planning in this high-risk group.
ISSN
1432-0932
Published In/Presented At
Ng, M. K., Mastrokostas, L. E., Mastrokostas, P. G., Baek, G., Dalton, J., Hitchner, M., Green, W. A., Mathew, J., Eichbaum, Y., Lee, Y., Fano, A., Giakas, A., Singh, R., Jagtiani, P., Bou Monsef, J., Razi, A. E., Fassett, D. R., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., … Alvarez, A. P. (2026). Dialysis status and its association with complications, discharge outcomes, and costs after multilevel lumbar fusion: a national analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 10.1007/s00586-026-09963-5. Advance online publication. https://doi.org/10.1007/s00586-026-09963-5
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42033620
Department(s)
Administration and Leadership
Document Type
Article