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Incidence of and factors associated with acute kidney injury after scoliosis surgery in pediatric patients

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Abstract

Purpose

We sought to identify the national incidence of acute kidney injury (AKI) associated with pediatric posterior spinal fusion (PSF) surgery for scoliosis, and to determine factors that increase risk.

Methods

The 1998–2014 National Inpatient Sample (NIS), a large United States hospital discharge database, was queried for discharges aged 0–17 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for scoliosis undergoing PSF for the outcome of AKI. Discharges were divided into those with AKI and unaffected. We fit adjusted logistic regression models to yield point estimates, odds ratios, 95% confidence intervals, and p values for the weighted, national population sample with postulated risk factors. The fit of the multivariable regression model was tested using the Hosmer–Lemeshow test, and collinearity using the variance inflation factor.

Results

The NIS contained 103,270 weighted discharges meeting inclusion criteria. AKI incidence was 0.1%. Multivariable logistic regression model showed significantly increased odds ratios with thrombocytopenia, rhabdomyolysis, chronic kidney disease, abnormal coagulation, and male sex. AKI increased both hospital stay and cost by threefold compared to unaffected children.

Conclusion

This study suggests that AKI after pediatric PSF is rare. It is associated with abnormal coagulation, chronic kidney disease, and rhabdomyolysis, but not with the number of vertebral levels fused. Female sex appears to be protective. The retrospective nature of study and reliance on ICD-9-CM codes may under-represent the incidence of AKI in pediatric PSF patients.

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This work was presented in part at the Annual Meeting of the American Society of Anesthesiologists, San Francisco, California, in October 2018.

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Funding

National Institutes of Health (Bethesda, MD) Grants EY027447 (to Dr. Roth), UL1TR002003 to the University of Chicago Institute for Translational Medicine, UL1TR002389 to the University of Illinois Clinical and Translational Sciences, and the Michael Reese Pioneers Award (Chicago, IL, to Dr. Roth).

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Authors and Affiliations

  1. Department of Anesthesiology, University of Illinois Hospital and Health Sciences, 1740 West Taylor Street, Suite 3200 W, M/C 515, Chicago, IL, 60612, USA

    Jamey E. Eklund, Helen H. Lee & Steven Roth

  2. Department of Anesthesiology, Shriners Hospital for Children, Chicago, Chicago, IL, USA

    Jamey E. Eklund & Helen H. Lee

  3. Department of Anesthesiology, Walter Read National Military Medical Center, Bethesda, MD, USA

    Shikhar H. Shah

  4. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA

    Daniel S. Rubin

  5. Department of Neurosurgery, University of Illinois Hospital and Health Sciences, Chicago, IL, USA

    Ankit I. Mehta

  6. Nephrology Associates of Northern Illinois and Indiana, Mount Prospect, IL, USA

    Evgueni M. Minev

Authors
  1. Jamey E. Eklund
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  2. Shikhar H. Shah
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  3. Daniel S. Rubin
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  4. Ankit I. Mehta
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  5. Evgueni M. Minev
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  6. Helen H. Lee
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  7. Steven Roth
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Contributions

JEE: Primary author who conceived and designed study, identified diagnoses and procedures, reviewed results, composed and revised manuscript. Approved final version; SHS: Assisted with data acquisition and statistical analysis, and organized data into tables. Approved final version; DSR: Assisted with database search, data acquisition and statistical analysis, and reviewed results. Approved final version; EMM: Assisted with conception of the study, reviewed results, and revised manuscript for important intellectual content. Approved final version; AIM: Reviewed results and revised manuscript for important intellectual content. Approved final version; HHL: Reviewed results and revised manuscript for important intellectual content. Approved final version; SR: Assisted with study conception and project planning, reviewed data and analyses, and assisted with drafting and reviewing of manuscript. Approved final version

Corresponding author

Correspondence to Jamey E. Eklund.

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No IRB approval required. “Exempt” status by University of Illinois at Chicago IRB.

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Eklund, J.E., Shah, S.H., Rubin, D.S. et al. Incidence of and factors associated with acute kidney injury after scoliosis surgery in pediatric patients. Spine Deform 8, 991–999 (2020). https://doi.org/10.1007/s43390-020-00126-0

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