Impact of diabetic kidney disease on perioperative outcomes after lumbar spinal fusion: a propensity score analysis of the Nationwide Inpatient Sample.

BACKGROUND

Diabetic kidney disease (DKD) is a common complication of diabetes mellitus and an important determinant of perioperative outcomes. However, its impact on lumbar spinal fusion (LSF) has not been well established.

METHODS

We retrospectively analyzed 242,415 LSF patients from the National Inpatient Sample (2015-2019), identifying 5,278 with DKD. Propensity score matching (1:2) was performed, and multivariable logistic regression assessed the association between DKD and perioperative complications across six organ-system categories, as well as hospital outcomes. Subgroup analyses compared risks between type 1 DKD (T1DKD) and type 2 DKD (T2DKD).

RESULTS

DKD prevalence among LSF patients rose from 0.46% in 2015 to 3.27% in 2019. Compared with matched non-DKD patients, DKD was independently associated with elevated risks of cardiovascular (acute myocardial infarction aOR 2.183; acute cerebrovascular disease aOR 1.742), digestive (severe malnutrition aOR 1.45), neurologic (CNS inflammation aOR 3.043; stroke aOR 1.629; postoperative delirium aOR 1.313), respiratory (continuous trauma ventilation aOR 1.311), surgical (pressure injury aOR 2.218; transfusion aOR 1.255), and urinary complications (acute renal failure aOR 3.202; urinary tract infection aOR 1.361; urinary retention aOR 1.171). Hospital outcomes were also worse, including prolonged length of stay (aOR 1.336) and greater likelihood of discharge to skilled nursing or intermediate care facilities (aOR 1.407). Subgroup analysis demonstrated that T1DKD patients were more prone to infection- and metabolism-related complications, while T2DKD patients were predominantly affected by cardiovascular, nutritional, and care-dependency outcomes.

CONCLUSIONS

DKD substantially increases the risk of systemic complications and adverse hospital outcomes after LSF, with distinct risk patterns between type 1 and type 2 disease. These findings emphasize the need for DKD-specific perioperative risk stratification and tailored management strategies.