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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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The preoperative GFR as a predictive parameter for the course of spondylodiscitis

Die präoperative GFR als prognostischer Parameter für den Verlauf der Spondylodiszitis

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  • presenting/speaker Maximilian Lenz - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Maximilian Horbach - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Arne Harland - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Philipp Egenolf - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Vincent Johann Heck - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Paul Brinkötter - Universitätsklinikum Köln, Klinik für Innere Medizin II, Nephrologie, Köln, Deutschland
  • Krishnan Sircar - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Max J. Scheyerer - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Peer Eysel - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV092

doi: 10.3205/22dgnc094, urn:nbn:de:0183-22dgnc0941

Published: May 25, 2022

© 2022 Lenz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Despite all the advances in the treatment of spinal infections, they are still associated with high morbidity and mortality, and the incidence is increasing. In addition to prompt diagnosis, the early start of treatment is essential for the clinical course, although surgical intervention is required in many cases. Despite surgical rehabilitation and targeted antibiotic therapy, the complication rate is high, which is not least influenced by the mostly accompanying comorbidities. The aim of the present study was to evaluate the status of the preoperative kidney function as a risk factor for the clinical course in this particular patient group.

Methods: 369 patients who were treated surgically between 01/2015 and 10/2020 for spondylodiscitis were retrospectively analyzed. The kidney function was classified on the basis of the glomerular filtration rate (GFR) measured at the beginning of the hospital stay based on the GFR stages defined by the KDIGO for the classification of the impaired kidney function.

Results: 255 patients were included in the study (173 men, 82 women). The mean age was 66.3 ± 13.3 years. Chronic kidney damage was already known preoperatively in 14.1% (n = 36) of the patients. At the time of inpatient admission, 29% (n=74) patients had a GFR <60mL/min.Patients with a GFR <60mL/min spent an average of 5 days longer in hospital than those with a GFR >60mL/min (36 to 31 days) (p=0.071). Mortality also increased significantly as the GFR decreased. With a GFR of >60mL/min this was 7.3% and rose continuously (GFR <60mL/min: 17.6%; GFR <30mL/min: 30.4%) (p=0.003). In addition, patients with impaired GFR showed increased postoperative complications. The rate of revision operations increases significantly from a GFR <30mL/min, although not significantly (p=0.087).

Conclusion: The present work showed that the preoperative GFR is a good prognostic factor for predicting the clinical course in patients with spondylodiscitis. In particular, the length of hospital stay, postoperative complications, revisions, and mortality were significantly increased in patients with a lower GFR. The preoperative GFR is therefore an important parameter for estimating the individual perioperative risk.