Postoperative Complications and Survival Rate in Hemodialysis-Dependent Patients Undergoing Cervical Spine Surgery

INTRODUCTION: Spine surgery is challenging in hemodialysis (HD)-dependent patients owing to their poor general condition. However, postoperative complications and the mortality and survival rates have not been specifically evaluated in a wide series. This study aimed to elucidate postoperative complications and the survival rate in cervical spine surgery in HD patients. METHODS: This study included 109 HD patients (70 men, 39 women) who had undergone cervical spine surgery between July 1996 and May 2018. Based on radiological diagnosis, we divided them into the destructive spondyloarthropathy (DSA) and non-DSA groups. We investigated the causes of hemodialysis, postoperative complications, postoperative inpatient mortality rate, and survival rate. RESULTS: The DSA and non-DSA groups included 100 surgeries in 89 patients and 21 surgeries in 20 patients, respectively. The mean age at surgery was 62.9 years for the DSA and 55.9 years for the non-DSA group (P=0.97). The DSA group had a shorter hemodialysis period at surgery compared with the non-DSA group (21.7 vs. 26.5 years, P<0.05). The two most common causes of HD in both groups were chronic glomerulonephritis (DSA, 45%; non-DSA, 57.1%) and diabetes (DSA, 11%; non-DSA, 14.5%). Postoperative complications were observed in 23% (23/100) and 19% (4/21) of surgeries in the DSA and non-DSA groups, respectively (P=0.782). The total in-hospital mortality rate was 2.5% (3/121). The 1-, 3-, 5-, and 10-year postoperative survival rates of all patients were 89.6%, 75.5%, 67.1%, and 44.7%, respectively. The survival rates did not depend on the group (DSA vs. non-DSA), pre- and postoperative Japanese Orthopedic Association score for cervical myelopathy, hemodialysis period, sex, and age (P>0.05). However, significantly low survival rates were observed in HD caused by diabetes compared with that by chronic glomerulonephritis (P<0.001) and other causes (P<0.001). CONCLUSIONS: Cervical spine surgery in HD patients is associated with postoperative complications. The postoperative survival rate was found to be low if the cause of hemodialysis was diabetes.