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Research ArticleCervical Spine

Preoperative Dehydration Predicts Adverse Events Following Anterior Cervical Discectomy and Fusion

Abdullah Ghali, Gautham Prabhakar, David Momtaz, Farhan Ahmad, Adam Abbas, Muhammad Shamim, Mahmoud Issa, Varun Bora and Christopher Chaput
International Journal of Spine Surgery December 2023, 17 (6) 835-842; DOI: https://doi.org/10.14444/8544
Abdullah Ghali
1 Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
MD
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  • For correspondence: ghaliabdullah@gmail.com
Gautham Prabhakar
2 Department of Orthopedics, UT Health San Antonio, San Antonio, TX, USA
MD
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David Momtaz
2 Department of Orthopedics, UT Health San Antonio, San Antonio, TX, USA
BS
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Farhan Ahmad
3 Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
MD
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Adam Abbas
1 Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
BS
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Muhammad Shamim
1 Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
BS
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Mahmoud Issa
1 Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
BS
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Varun Bora
1 Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
MD
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Christopher Chaput
2 Department of Orthopedics, UT Health San Antonio, San Antonio, TX, USA
MD
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  • Article
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Article Figures & Data

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  • Figure 1
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    Figure 1

    Plot displaying the odds ratios for postoperative complications when comparing dehydrated and not dehydrated patients. Age, sex, ethnicity, race, and body mass index were adjusted for.

  • Figure 2
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    Figure 2

    Plot displaying bar graph representation of 30-day mortality, postoperative complications, modified comprehensive complication index 50+, and Clavien-Dindo grade IV when comparing dehydrated and not dehydrated patients.

  • Figure 3
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    Figure 3

    Plot displaying bar graph representation of complications, reoperation, readmission, and hospital length of stay when comparing dehydrated and not dehydrated patients.

Tables

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    Table 1

    Patient demographics, operative time, length of hospital stay, and probability of morbidity and mortality for the dehydrated and not dehydrated groups.

    Patient DemographicDehydration (Blood Urea Nitrogen/Creatinine >20) P
    Not DehydratedDehydrated
    MeanSDMeanSD
    Age, y54.6511.4059.5211.22<0.001
    Body mass index30.666.4230.536.790.272
    Estimated probability of morbidity2.26%1.22%2.60%1.56%<0.001
    Estimated probability of mortality0.18%0.83%0.30%1.07%<0.001
    Length of total hospital stay, d1.833.072.394.21<0.001
    Total operation time, min130.0271.23135.3475.71<0.001
    N % N %
    Sex
     Women482445.0%257361.2%<0.001
     Men590155.0%163338.8%
    Race
     Not Black912585.1%391093.0%<0.001
     Black160114.9%2967.0%
    Ethnicity
     Not Hispanic10,06293.8%392493.3%<0.001
     Hispanic6646.2%2826.7%
    • View popup
    Table 2

    ASA scores, comorbidities, and MCCI for the dehydrated and not dehydrated groups.

    VariablesDehydration (Blood Urea Nitrogen/Creatinine >20) P
    Not DehydratedDehydrated
    N % N %
    ASA Classification
     13173.0%982.3%<0.001
     2563752.6%196746.8%
     3451742.1%199347.4%
     42472.3%1433.4%
     510.0%20.0%
     None assigned70.1%30.1% 
    Osteoporosis Diagnosis
     No10,71399.9%419999.8% 
     Yes130.1%70.2% 
    History of Congestive Heart Failure
     No10,68999.7%418899.6% 
     Yes370.3%180.4% 
    History of Hypertension
     No567352.9%200747.7% 
     Yes505347.1%219952.3% 
    History of Severe COPD
     No10,28095.8%400395.2% 
     Yes4464.2%2034.8% 
    Diabetes
     No895183.5%331478.8% 
     Yes177516.5%89221.2% 
    MCCI Score by Increments
     010,34996.5%398194.7%<0.001
     0–251241.2%721.7%
     25–421781.7%852.0%
     42–50410.4%320.8%
     50+340.3%360.9%
    • Abbreviations: ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease; MCCI, modified comprehensive complication index.

    • Note: P values are provided where applicable.

    • View popup
    Table 3

    30-day complications, Clavien-Dindo grade IV, and mortality for the dehydrated and not dehydrated groups.

    ComplicationDehydration (Blood Urea Nitrogen/Creatinine >20) P
    Not DehydratedDehydrated
    N % N %
    Any
     No10,32896.3%396694.3%<0.001
     Yes3983.7%2405.7% 
    Pulmonary (combined)
     No10,59398.8%410397.6%<0.001
     Yes1331.2%1032.4% 
    Cardiac (combined)
     No10,69899.7%418399.5%0.006
     Yes280.3%230.5% 
    Wound (combined)
     No10,60398.9%413298.2%0.002
     Yes1231.1%741.8% 
    Hematological (combined)
     No10,65199.3%415098.7%<0.001
     Yes750.7%561.3% 
    Renal (combined)
     No10,70899.8%420299.9%0.214
     Yes180.2%40.1% 
    Clavien-Dindo Grade IV
     No10,66499.4%414898.6%<0.001
     Yes620.6%581.4% 
    30-d Mortality
     Lived10,70599.8%418699.5%0.003
     Death in 30 days210.2%200.5%
    • View popup
    Table 4

    Readmission, reoperation, discharge destination, and delayed hospital lengths of the stays ( >5, >7, >10, and >15 d) for the dehydrated and not dehydrated groups.

    VariablesDehydration (Blood Urea Nitrogen/Creatinine >20) P
    Not DehydratedDehydrated
    N % N %
    Readmission
     No10,40197.0%404596.2%0.008
     Yes3253.0%1613.8% 
    Reoperation
     No10,53598.2%410597.6%0.008
     Yes1911.8%1012.4% 
    Discharge Destination
     Home10,22895.4%378890.1%<0.001
     Not home4984.6%4189.9% 
    Delayed Hospital Stay (>5 d)
     No10,04793.7%375589.3%<0.001
     Yes6796.3%45110.7% 
    Delayed Hospital Stay (>7 d)
     No10,33096.3%390992.9%<0.001
     Yes3963.7%2977.1% 
    Delayed Hospital Stay (>10 d)
     No10,52598.1%402795.7%<0.001
     Yes2011.9%1794.3% 
    Delayed Hospital Stay (>15 d)
     No10,62799.1%411797.9%<0.001
     Yes990.9%892.1%
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International Journal of Spine Surgery
Vol. 17, Issue 6
1 Dec 2023
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Preoperative Dehydration Predicts Adverse Events Following Anterior Cervical Discectomy and Fusion
Abdullah Ghali, Gautham Prabhakar, David Momtaz, Farhan Ahmad, Adam Abbas, Muhammad Shamim, Mahmoud Issa, Varun Bora, Christopher Chaput
International Journal of Spine Surgery Dec 2023, 17 (6) 835-842; DOI: 10.14444/8544

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Preoperative Dehydration Predicts Adverse Events Following Anterior Cervical Discectomy and Fusion
Abdullah Ghali, Gautham Prabhakar, David Momtaz, Farhan Ahmad, Adam Abbas, Muhammad Shamim, Mahmoud Issa, Varun Bora, Christopher Chaput
International Journal of Spine Surgery Dec 2023, 17 (6) 835-842; DOI: 10.14444/8544
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Keywords

  • ACDF
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  • dehydration
  • cervical spine
  • fusion
  • discectomy
  • NSQIP
  • risk
  • complications
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  • big data

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