Key result
The incidence of acute kidney injury after elective spine surgery was 0.10%, with anemia, chronic kidney disease, diabetes, and hypertension identified as significant risk factors.
Why the study?
Spine surgery is common and acute kidney injury is a frequent complication linked to morbidity and prolonged hospital stays, but limited data exist on specific risk factors in this population.
Cohort (n=351,998)
Yes
Acute kidney injury is a rare (0.10%) complication after elective spine surgery, but is associated with modifiable baseline comorbidities such as anemia, chronic kidney disease, and hypertension.
May inform perioperative AKI risk stratification in elective spine surgery; leaves open need for prospective validation before practice change.
STUDY DESIGN: This was a retrospective review using the ACS-NSQIP database. OBJECTIVE: To investigate the incidence of acute kidney injury (AKI) in elective spine surgery and identify risk factors associated with its development. SUMMARY OF BACKGROUND DATA: Spine surgery is the most common type of surgery in the United States, with AKI being a frequent postoperative complication. AKI is linked to increased morbidity, prolonged hospital stays, and higher costs. However, limited data exist on specific risk factors for AKI in spine surgery patients. METHODS: Patients undergoing elective spine surgery were identified using CPT codes from the ACS-NSQIP database. AKI was defined based on perioperative laboratory values. Propensity matching was applied to identify associated risk factors. Univariate and multivariate analyses were performed on the matched cohort to assess preoperative characteristics and postoperative outcomes. RESULTS: Among 351,998 elective spine procedures, the incidence of postoperative AKI was 0.10% (373 patients). AKI patients were more likely to be non-Hispanic Black (14.7% vs. 9.5%, P=0.033), have a higher BMI (33.2 vs. 31.5, P=0.006), anemia (49.3% vs. 33.6%, P<0.001), chronic kidney disease (20.4% vs. 15%, P=0.024), diabetes (44.2% vs. 29.5%, P<0.001), and hypertension (83.1% vs. 74.5%, P<0.001). Preoperative lab values showed higher BUN (22.9 vs. 20.5, P=0.010), INR (1.1 vs. 1.0, P<0.001), and PT (12.4 vs. 11.1, P=0.015), but lower sodium (138.8 vs. 139.3, P=0.008) and hematocrit (38.7 vs. 40.9, P<0.001). When stratified by surgical procedure type, including ACDF, cervical decompression, lumbar decompression, and lumbar fusion, there was no statistically significant difference in AKI incidence (P=0.364). CONCLUSIONS: The incidence of AKI after elective spine surgery is 0.10%. Addressing modifiable risk factors, such as anemia, chronic kidney disease, and hypertension, can help reduce postoperative complications. LEVEL OF EVIDENCE: This study is classified as level III evidence, as it is a retrospective cohort study utilizing the ACS-NSQIP database.
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Castillo et al. (2025) conducted a cohort in Elective spine surgery (n=351,998). Elective spine surgery was evaluated on Postoperative acute kidney injury (AKI). The incidence of acute kidney injury after elective spine surgery was 0.10%, with anemia, chronic kidney disease, diabetes, and hypertension identified as significant risk factors.
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