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Ramamurti P, Fassihi SC, Sacolick D, Gu A, Wei C, Chodos MD. Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. Hip Int 2023; 33:345-353. [PMID: 34191641 DOI: 10.1177/11207000211028502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. METHODS The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer's exact and analysis of variance testing. RESULTS The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs (p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 (p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90-120 (p < 0.001). CONCLUSIONS This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - David Sacolick
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Marc D Chodos
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
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Jakuscheit A, Schaefer N, Roedig J, Luedemann M, von Hertzberg-Boelch SP, Weissenberger M, Schmidt K, Holzapfel BM, Rudert M. Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty. J Pers Med 2021; 11:jpm11111223. [PMID: 34834575 PMCID: PMC8622846 DOI: 10.3390/jpm11111223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. METHODS We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. RESULTS 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m2, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. CONCLUSION The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.
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Affiliation(s)
- Axel Jakuscheit
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
- Correspondence:
| | - Nina Schaefer
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
| | - Johannes Roedig
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
| | - Martin Luedemann
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
| | - Sebastian Philipp von Hertzberg-Boelch
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
| | - Manuel Weissenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
| | - Karsten Schmidt
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany;
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, Marchionistr. 15, 81377 Munich, Germany;
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany; (N.S.); (J.R.); (M.L.); (S.P.v.H.-B.); (M.W.); (M.R.)
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Papalia R, Zampogna B, Torre G, Papalia GF, Vorini F, Bravi M, Albo E, De Vincentis A, Denaro V. Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty-Our Experience on 743 Cases. J Clin Med 2021; 10:jcm10215053. [PMID: 34768573 PMCID: PMC8584853 DOI: 10.3390/jcm10215053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this retrospective investigation is to evaluate the correlation between several preoperative and perioperative factors and the length of hospital stay in patients that underwent elective total hip arthroplasty with overnight admission. Medical records of patients that underwent THA from the beginning of 2016 to the end of 2018 were retrospectively screened. Demographics, comorbidities, whole blood count, intraoperative details, and length of postoperative stay were retrieved. The association between clinical, laboratory and surgical factors and the length of hospital stay was explored by means of negative binomial and logistic regression models. The median length of postoperative hospital stay was four days (Inter Quartile Range, IQR 3, 5). After univariate regression a stepwise multivariate regression showed that operative time (p = 0.001), the preoperative serum creatinine (p < 0.001), the intraoperative blood loss (p = 0.04) and the use of an anterolateral approach (p < 0.001) were found to correlate significantly with the increase of the hospitalization length, while no significant correlation was found for all the other features. Multivariable model fitted through logistic regression (LOS below or over the median value of four days) had an Area Under the Curve (AUC) of 0.748. Our analysis suggests a significant role played by different preoperative and perioperative variables in influencing the length of hospital stay.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
| | - Biagio Zampogna
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
- Multi-Specialist Clinical Institute for Orthopaedic Trauma Care (COT), 98124 Messina, Italy
| | - Guglielmo Torre
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
- Correspondence:
| | - Giuseppe Francesco Papalia
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
| | - Ferruccio Vorini
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
| | - Marco Bravi
- Department of Physical Therapy and Rehabilitation, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Erika Albo
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
| | - Antonio De Vincentis
- Department of Internal Medicine and Geriatrics, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Vincenzo Denaro
- Department of Orthopedics and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (B.Z.); (G.F.P.); (F.V.); (E.A.); (V.D.)
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Cheng C, Yan Y, Zhang Q, Guo W. Effect of chronic kidney disease on total knee arthroplasty outcomes: a meta-analysis of matched control studies. ARTHROPLASTY 2021; 3:21. [PMID: 35236487 PMCID: PMC8796397 DOI: 10.1186/s42836-021-00078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The purpose of this meta-analysis was to review the current evidence in the literature to find out whether the coexisting chronic kidney disease affected infection, revision, transfusion, readmission, mortality, and the length of hospital stay after total knee arthroplasty. Methods Medline, PubMed, Embase, and the Cochrane Library were searched from their dates of inception to June 30, 2020. The primary outcomes were postoperative infection, revision, and mortality. The secondary outcomes were transfusion, the length of hospital stay, and readmission. A P value of < 0.05 was deemed to be statistically significant. Results A total of 881 articles were identified, and 7 articles that met the inclusion criteria were identified to be eligible. The most important finding of our study was that the chronic kidney disease was associated with increased postoperative transfusion (P < 0.05) and mortality (P < 0.05). Meanwhile, the patients with chronic kidney disease were associated with a higher readmission rate, compared to the patients without chronic kidney disease (P < 0.05). However, chronic kidney disease was not associated with high risks for infection (P > 0.05), revision surgeries (P > 0.05), and a prolonged hospital stay (P > 0.05). Conclusions After total knee arthroplasty, the patients with coexisting chronic kidney disease carry higher risks of transfusion, mortality, and readmission. However, the chronic kidney disease may not be associated with the risk of infection or revision, nor the duration of hospitalization.
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Affiliation(s)
- Chongjie Cheng
- Graduate School of Peking Union Medical College, Beijing, China.,China-Japan Friendship Institute of Clinical Medicine, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yan Yan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Peking University China-Japan, Friendship Institute of Clinical Medicine, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College, Beijing, China. .,China-Japan Friendship Institute of Clinical Medicine, Beijing, China. .,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
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Mazza D, Calderaro C, Iorio R, Drogo P, Andreozzi V, Ferretti A. Acute kidney failure after total knee arthroplasty revision with antibiotic-impregnated cement spacer. Orthop Rev (Pavia) 2020; 12:8540. [PMID: 32922700 PMCID: PMC7461639 DOI: 10.4081/or.2020.8540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Gentamicin-impregnated cement beads and spacers are frequently used in case of infective complications after Total Knee Arthroplasty (TKA). A great number of studies in the literature demonstrated that the local administration of gentamicin produces high local antibiotic levels but low serum and urine gentamicin concentrations. Gentamicin-impregnated cement spacer can induce nephrotoxicity in patients presenting major renal impairment susceptibility. We report a case of acute renal failure using a gentamicin-impregnated block spacer. An 83-year-old woman underwent a gentamicinimpregnated bone-cement spacer implant because of an infected TKA removal. Three days later patient clinical status got worse reporting a decreased urine output and increasing C-reactive protein (CRP), Serum Creatinine (SCr) and Blood Urea Nitrogen (BUN). Because the symptoms could be related to the knee spacer lead us to the decision of gentamicin-impregnated cement spacer removal. The day following the removal procedure showed progressive improvement of general condition with evidence of SCr and BUN normalization. Gentamicin-impregnated cement spacer can induce nephrotoxicity in patients presenting major renal impairment susceptibility.
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Affiliation(s)
- Daniele Mazza
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - Cosma Calderaro
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - Raffaele Iorio
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - Piergiorgio Drogo
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - Valerio Andreozzi
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - Andrea Ferretti
- Department of Orthopedic and Traumatology, S. Andrea Hospital, "La Sapienza" University of Rome, Italy
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Luan-Erfe BM, Yilmaz M, Sweitzer B. Preoperative Intravenous Iron and Erythropoietin to Treat Severe Anemia in Patient With Stage 4 Kidney Disease Before Oncologic Surgery: A Case Report. A A Pract 2020; 14:e01234. [PMID: 32496428 DOI: 10.1213/xaa.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preoperative treatment of anemia with intravenous iron is inconsistent despite known risks of anemia and allogeneic blood transfusions. Limited research exists on the effectiveness of preoperative intravenous iron for chronic kidney disease (CKD) patients. We discuss a patient with severe anemia from advanced CKD, endometrial cancer, and menometrorrhagia. Her hemoglobin increased more than 2 g/dL after erythropoietin and two 750-mg ferric carboxymaltose infusions 5 weeks before a total abdominal hysterectomy and avoided blood transfusions perioperatively. By raising hemoglobin, preoperative intravenous iron and erythropoietin reduce blood transfusions and consequent risk of future allograft rejection and alloimmunization in potential transplant recipients.
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Affiliation(s)
- Betty M Luan-Erfe
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Hu C, Wang YH, Shen R, Liu C, Sun K, Ye L, Ye JJ, Yang X, Tian SQ, Yu TB. Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:315. [PMID: 32434505 PMCID: PMC7241000 DOI: 10.1186/s12891-020-03328-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/05/2020] [Indexed: 01/31/2023] Open
Abstract
Background The need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in patients following TKA and develop a nomogram. Methods The nomogram was developed based on a training set of 5402 patients who underwent TKA at the Affiliated Hospital of Qingdao University between September 2013 and November 2018. The independent predictors of transfusion were identified by univariate, LASSO, and binary logistic regression analyses. Then, a nomogram was established based on these independent predictors. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. The results were validated using an independent set of 1116 patients who underwent TKA between December 2018 and September 2019. In addition, we also carried out subgroup analyses in the training and testing sets based on the independent predictors. Results Five independent predictors were identified by multivariate analysis and were used to establish the nomogram. The AUCs of the nomogram were 0.884 (95% CI: 0.865–0.903) and 0.839 (95% CI, 0.773–0.905) in the training and testing sets, respectively. In both the training and testing sets, the calibration curve indicated that the prediction by the nomogram was highly consistent with the actual observation, and the DCA indicated that the nomogram had a favorable level of clinical usefulness. In addition, the AUC of the nomogram was significantly higher than the AUC of any independent predictor for predicting transfusion risk following TKA, and the subgroup analysis showed good performance in 20 subgroups. Conclusion Lower preoperative Hb levels, simultaneous bilateral TKA, lower BMI, older age, and coronary heart disease were identified as independent predictors of postoperative transfusion in patients following TKA. A nomogram incorporating the above five predictors could accurately predict the transfusion risk.
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Affiliation(s)
- Chuan Hu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Yuan-He Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Rui Shen
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Chuan Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Kang Sun
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Lin Ye
- Wenzhou Medical University, Wenzhou, 325000, China
| | - Jian-Jun Ye
- Wenzhou Medical University, Wenzhou, 325000, China
| | - Xu Yang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Shao-Qi Tian
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China.
| | - Teng-Bo Yu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China.
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Impact of chronic kidney disease on outcomes after total joint arthroplasty: a meta-analysis and systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 44:215-229. [DOI: 10.1007/s00264-019-04437-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
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