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Inoue A, Arai Y, Yoshihara Y, Nakagawa S, Takahashi K. Staged Bi-compartmental Knee Arthroplasty for Contralateral Compartment Failure After Medial Unicompartmental Knee Arthroplasty in Dialysis Patients: Two Case Reports. Cureus 2024; 16:e62892. [PMID: 39040782 PMCID: PMC11262787 DOI: 10.7759/cureus.62892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a minimally invasive surgical technique with good clinical outcomes; however, its outcomes in patients undergoing hemodialysis are unknown. Herein, we report two cases of patients undergoing hemodialysis who underwent staged bi-compartmental UKA (Bi-UKA) for early contralateral compartment failure after medial UKA. We describe the case of early contralateral compartment failure after medial UKA in two women patients aged 71 and 72 years with a dialysis history of seven and 22 years, respectively. Three months after right medial UKA, she had persistent joint edema and arthralgia after minor trauma, with recurrent gait disturbance in the first case. An MRI showed a bone marrow lesion in the contralateral compartment, and a lateral UKA was added. In the second case, the knee pain worsened without any trigger three years after leaving the medial UKA. A subchondral insufficiency fracture (SIF) was diagnosed by a plain radiograph showing a radiolucent area on the lateral femoral condyle. Gait disturbance did not improve, and a lateral UKA was performed. In our hospital, medial UKA was performed on seven knees of dialysis patients in 10 years since 2011, and contralateral compartment failure was observed in two knees at an early stage. In both cases, lumbar bone density was normal and there was no postoperative overcorrection in leg alignment, but a SIF of the contralateral side occurred, suggesting that bone fragility of the contralateral compartment due to long-term dialysis was the underlying cause. Staged Bi-UKA was minimally invasive and useful as a revision surgery.
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Affiliation(s)
- Atsuo Inoue
- Orthopedics, Kyoto Prefectural University of Medicine, Kyoto, JPN
- Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Yuji Arai
- Sports and Para-Sports Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Yasushi Yoshihara
- Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Shuji Nakagawa
- Sports and Para-Sports Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Kenji Takahashi
- Orthopedics, Kyoto Prefectural University of Medicine, Kyoto, JPN
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2
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Venishetty N, Wukich DK, Beale J, Riley Martinez J, Toutoungy M, Mounasamy V, Sambandam S. Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications. Knee Surg Relat Res 2023; 35:22. [PMID: 37533126 PMCID: PMC10394770 DOI: 10.1186/s43019-023-00196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing disease that affects millions of people in the USA every year. Many CKD patients progress to end-stage renal disease (ESRD), necessitating the use of hemodialysis to alleviate symptoms and manage kidney function. Furthermore, many of these patients have lower bone quality and experience more postoperative complications. However, there is currently limited information on hospitalization information and perioperative complications in this population following procedures such as total knee arthroplasty (TKA). The purpose of this study was to assess the patient characteristics, demographics, and prevalence of postoperative problems among dialysis patients who received TKA. METHODS In this retrospective study, we used the Nationwide Inpatient Sample (NIS) data from 2016 to 2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as dialysis patients, compared with those who were not. Propensity matching was conducted to consider associated factors that may influence perioperative complications. RESULTS From 2016 to 2019, 558,371 patients underwent TKAs, according to the National In-Sample (NIS) database. Of those, 418 patients (0.1%) were in the dialysis group, while the remaining 557,953 patients were included in the control group. The mean age of the dialysis group was 65.4 ± 9.8 years, and the mean age in the control group was 66.7 ± 9.5 years (p = 0.006). After propensity matching, dialysis group patients had a higher risk of receiving blood transfusions [odds ratio (OR): 2; 95% confidence interval (CI): 1.2, 3.4] and a significantly larger COC in comparison to those in the control group (91,434.3 USD versus 71,943.6 USD, p < 0.001). In addition, dialysis patients had significantly higher discharges to another facility, as compared with the control group patients. CONCLUSIONS The dialysis group had a significantly higher cost of care, higher rates of requiring blood transfusion, and more cases of being discharged to another facility than non-dialysis patients. This data will help providers make informed decisions about patient care and resource allocation for dialysis patients undergoing TKA.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
| | - Dane K Wukich
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - J Riley Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - Michel Toutoungy
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
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3
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Jin H, He M, Yang G, Xie W, Yu D, Li H, Xiao W, Li Y. A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease. Orthop Surg 2022; 15:591-605. [PMID: 36453119 PMCID: PMC9891927 DOI: 10.1111/os.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients. METHODS From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8 ± 13.4 years old) and 31 non-CKD patients (mean age 69.4 ± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin. RESULTS All patients included in the retrospective study had an average preoperative preparation time of 4.3 ± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P > 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.001). CONCLUSION Patients with CKD have distinct characteristics compared to non-CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty.
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Affiliation(s)
- Hongfu Jin
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Miao He
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Guang Yang
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Wenqing Xie
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Dengjie Yu
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Hengzhen Li
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Wenfeng Xiao
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Yusheng Li
- Department of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina,National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
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4
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Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: Chronic Kidney Disease Disparities. J Am Acad Orthop Surg 2022; 30:1064-1068. [PMID: 35427242 DOI: 10.5435/jaaos-d-21-00919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
Approximately 15% of the American adults have chronic kidney disease (CKD). Rates of CKD are higher in underserved communities: It is highest in African Americans (16%) and Hispanic individuals (14%). African Americans are more than 3 times as likely compared with their White counterparts to develop end-stage kidney disease, requiring dialysis or a kidney transplant. Rates of CKD are higher in the geriatric and socioeconomic disadvantaged populations, groups with higher rates of hip and knee osteoarthritis and with comorbidities, including obesity, diabetes mellitus, heart disease, and hypertension. CKD of any stage is associated with increased postoperative readmission, complications, and mortality. Patients on hemodialysis after total joint arthroplasty are at increased risk for complications, including periprosthetic joint infection, and given the reduction in risk after kidney transplant, there is varying opinion regarding whether patients on hemodialysis are safe arthroplasty candidates.
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Wang KY, Puvanesarajah V, Raad M, Barry K, Srikumaran U, Thakkar SC. The BTK Safety Score: A Novel Scoring System for Risk Stratifying Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg 2022; 36:702-709. [PMID: 34979584 DOI: 10.1055/s-0041-1741000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Selection of appropriate candidates for simultaneous bilateral total knee arthroplasty (si-BTKA) is crucial for minimizing postoperative complications. The aim of this study was to develop a scoring system for identifying patients who may be appropriate for si-BTKA. Patients who underwent si-BTKA were identified in the National Surgical Quality Improvement Program database. Patients who experienced a major 30-day complication were identified as high-risk patients for si-BTKA who potentially would have benefitted from staged bilateral total knee arthroplasty. Major complications included deep wound infection, pneumonia, renal insufficiency or failure, cerebrovascular accident, cardiac arrest, myocardial infarction, pulmonary embolism, sepsis, or death. The predictive model was trained using randomly split 70% of the dataset and validated on the remaining 30%. The scoring system was compared against the American Society of Anesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and legacy risk-stratification measures, using area under the curve (AUC) statistic. Total 4,630 patients undergoing si-BTKA were included in our cohort. In our model, patients are assigned points based on the following risk factors: +1 for age ≥ 75, +2 for age ≥ 82, +1 for body mass index (BMI) ≥ 34, +2 for BMI ≥ 42, +1 for hypertension requiring medication, +1 for pulmonary disease (chronic obstructive pulmonary disease or dyspnea), and +3 for end-stage renal disease. The scoring system exhibited an AUC of 0.816, which was significantly higher than the AUC of ASA (0.545; p < 0.001) and CCI (0.599; p < 0.001). The BTK Safety Score developed and validated in our study can be used by surgeons and perioperative teams to risk stratify patients undergoing si-BTKA. Future work is needed to assess this scoring system's ability to predict long-term functional outcomes.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Varun Puvanesarajah
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Micheal Raad
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kawsu Barry
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Umasuthan Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Savyasachi C Thakkar
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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6
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Kothandaraman V, Kunkle B, Reid J, Oldenburg KS, Johnson C, Eichinger JK, Friedman RJ. Increased Risk of Perioperative Complications in Dialysis Patients Following Rotator Cuff Repairs and Knee Arthroscopy. Arthrosc Sports Med Rehabil 2021; 3:e1651-e1660. [PMID: 34977617 PMCID: PMC8689219 DOI: 10.1016/j.asmr.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the effects of dialysis on postoperative and perioperative complications following rotator cuff repair (RCR) and knee arthroscopy (KA). Methods The National Surgical Quality Improvement Program (NSQIP) was queried from 2006 to 2018. Groups were matched for age, sex, body mass index, smoking status, preoperative functional status, and the American Society of Anesthesiologists (ASA) status. Chi-squared tests and Fisher’s exact tests were used to analyze the comorbidities. Differences in occurrences of postoperative adverse events (AE), mortality within 30 days, reoperations with 30 days, extended hospital stay (≥2 days), and readmissions within 30 days were analyzed using the Mantel-Haenszel test. Sign tests were used to evaluate differences in operative time, as well as length of hospital stay. Results Dialysis patients in both the RCR and KA groups had greater odds of experiencing any AE (OR: 6.33 and 7.46, P value: .031 and <.001, respectively) and readmission within 30 days (OR: 10.5 and 4.1, P value: .015 and .014, respectively). They also had significantly greater operating times (P = .049 for both). Dialysis patients undergoing KA had greater odds of staying in the hospital ≥2 days (OR: 10, P = <.001) and being reoperated on within 30 days (OR: 3.78, P = .033). The total hospital stay was significantly greater for dialysis patients in the KA group (P < .001) but not in the RCR group (P = .088). None of the individual AE’s significantly differed between the dialysis and non-dialysis patients in the RCR cohort; however, dialysis patients in the KA cohort had greater incidences of three AE’s. Conclusions This study identified significantly worse short-term complication rates in dialysis patients undergoing RCR and KA. Careful preoperative evaluation and postoperative surveillance are warranted in this high-risk patient group. Patients should be counseled appropriately on the increased complication risks associated with RCR and KA surgeries. Level of Evidence Level III, retrospective cohort study.
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7
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Chou TFA, Ma HH, Tsai SW, Chen CF, Wu PK, Chen WM. Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:618-628. [PMID: 34532070 PMCID: PMC8419801 DOI: 10.1302/2058-5241.6.200116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI). We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome. We included 22 studies and 9384 patients (dialysis, n = 8921, KT, n = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%. Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors. In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates.
Cite this article: EFORT Open Rev 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116
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Affiliation(s)
- Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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8
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Gkiatas I, Xiang W, Karasavvidis T, Windsor EN, Sharma AK, Sculco PK. Total knee arthroplasty in dialysis patients: Is it safe? A systematic review of the literature. J Orthop 2021; 25:199-206. [PMID: 34045823 DOI: 10.1016/j.jor.2021.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/09/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face. Results The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N = 925/3702), with incidence rates of 2.5%(N = 92/3702) for periprosthetic joint infection, 3.7%(N = 71/1895) for reoperations, and 2.5%(N = 90/3578) for mortality. Conclusion Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.
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Affiliation(s)
- Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - William Xiang
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Theofilos Karasavvidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eric N Windsor
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
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9
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Tang Y, Li H, Guo Z. Prediction of ICU admission after orthopedic surgery in elderly patients. Pak J Med Sci 2021; 37:1179-1184. [PMID: 34290804 PMCID: PMC8281162 DOI: 10.12669/pjms.37.4.3371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Prediction of ICU admission after surgery are important for rational decision-making for different patients in clinical practice. Little information is available about the risk factors of postoperative ICU admission in elderly patients undergoing orthopedic surgery. This study aimed to identify risk factors and develop a predictive model for postoperative ICU admission in elderly patients undergoing orthopedic surgery. Methods: A total of 2826 cases of elderly patients receiving orthopedic surgery from October 2010 to September 2016 were retrospectively collected and analyzed. Logistic regression was used to evaluate the impacts of covariates. Support vector machine (SVM) was employed to develop a predictive model based on all pre-operative covariates and the demographic information. Results: There were 256 patients transferred to ICU after surgery. ASA III or IV and emergency surgery were found to be independent risk factors while neuraxial anesthesia and joint surgery were protective factors. In addition, a SVM-based predictive model was developed, which had a sensitivity of 90.99%, a specificity of 99.10% and an area under ROC curve of 0.9678. Conclusions: Our study revealed that emergency surgery, anesthesia method, surgery type and ASA grade were risk factors to predict postoperative ICU admission in elderly orthopedic patients.
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Affiliation(s)
- Yongzhong Tang
- Dr. Yongzhong Tang, MD. Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Hao Li
- Dr. Hao Li, MD. Intensive Care Unit, Taikang Xianlin Drum Tower Hospital, Nanjing, China
| | - Ziyi Guo
- Dr. Ziyi Guo, MM. Department of Orthopedic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China. Department of Orthopedic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
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10
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Labaran LA, Sequeira S, Bolarinwa SA, Aryee J, Montgomery SR, Nwankwo E, Haug E, Bell J, Cui Q. Outcomes Following Revision Joint Arthroplasty Among Hemodialysis-Dependent Patients. J Arthroplasty 2020; 35:S273-S277. [PMID: 31780359 DOI: 10.1016/j.arth.2019.10.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/06/2019] [Accepted: 10/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) dependence is known to impact the integrity of bone and has long been associated with metabolic bone disease and other adverse events postoperatively. The aim of this study is to analyze postoperative outcomes following revision hip and knee arthroplasty in hemodialysis-dependent (HDD) patients and to characterize the common indications for revision procedures among this patient population. METHODS A total of 1779 HDD patients who underwent a revision joint arthroplasty (930 revision total knee arthroplasty [TKA] and 849 revision total hip arthroplasty [THA]) between 2005 and 2014 were identified from a retrospective database review. Our resulting study groups of revision TKA and THA HDD patients were compared to their respective matched control groups for hospital length of stay (LOS), 90-day mean total cost, hospital readmission, and other major medical and surgical complications. RESULTS HD was significantly associated with increased LOS (7.7 ± 8.3 vs 4.8 ± 4.5; P < .001), mean 90-day total cost ($47,478 ± $33,413 vs $24,286 ± $21,472; P < .001), hospital readmission (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.96-2.58; P < .001), septicemia (OR, 3.18; 95% CI, 2.70-3.74; P < .001), postoperative infection (OR, 1.72; 95% CI, 1.50-1.98; P < .001), and mortality (OR, 3.99; 95% CI, 3.12-5.06; P < .001) following revision TKA. Among revision THA patients, HD was associated with increased LOS (9.4 ± 9.5 vs 5.7 ± 5.7; P < .001), mean 90-day total cost ($40,182 ± $27,082 vs $26,519 ± $22,856; P < .001), hospital readmission (OR, 2.33; 95% CI, 2.02-2.68; P < .001), septicemia (OR, 3.61; 95% CI, 3.05-4.27; P < .001), and mortality (OR, 3.55; 95% CI, 2.86-4.37; P < .001). CONCLUSION HD remains a significant risk factor for increased LOS, mean total cost, hospital readmission, septicemia, and mortality following revision joint arthroplasty.
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Affiliation(s)
- Lawal A Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Sean Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | | | - Jomar Aryee
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Samuel R Montgomery
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Eugene Nwankwo
- Department of Orthopaedic Surgery, Texas Tech University, Lubbock, TX
| | - Emanuel Haug
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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11
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Wang YC, Cheng YJ, Yang JY, Chao CD, Huang JW, Hung KY. Is dialysis vintage a perioperative risk for end-stage renal disease patients receiving total knee and hip arthroplasty. J Orthop Surg (Hong Kong) 2020; 27:2309499019853887. [PMID: 31181995 DOI: 10.1177/2309499019853887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND End-stage renal disease is an independent risk factor for postoperative mortality and cardiovascular events, but dialysis vintage and its relationship with perioperative complication is not well studied. We did a population-based study to investigate this issue. MATERIALS AND METHODS We identified patients who had total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgeries during 1999-2010 from the National Health Insurance Research Database of Taiwan. Patients who had regular dialysis before surgery were recruited in our analysis. The outcome of interest was mortality, morbidities, intensive care unit admission rate, hospitalization duration, readmission rate, and medical costs. We did multivariate regression to adjust for age, sex, and Charlson comorbidity index (CCI) and to analyze the relationship of dialysis vintage and clinical outcomes. RESULTS A total of 518 patients were enrolled for analysis. A total of 286 patients had TKA surgeries and 232 patients had THA surgeries. Patients who had TKA surgery were older and had more medical comorbidities than patients who had THA. After adjustment for age, sex, and CCI, TKA patients who had dialysis vintage <3 years had significantly higher medical costs ( p < 0.05). For THA patients, dialysis vintage is not an independent risk factor for outcomes of interest. CONCLUSION Perioperative complication is associated with age and medical comorbidities. Longer dialysis vintage is not related to perioperative morbidities and mortalities or higher medical costs in either TKA or THA patients.
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Affiliation(s)
- Yi-Chia Wang
- 1 Department of Anesthesiology, National Taiwan University Hospital, Taipei
| | - Ya-Jung Cheng
- 1 Department of Anesthesiology, National Taiwan University Hospital, Taipei
| | - Ju-Yeh Yang
- 2 Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City.,3 Department of Quality Management Center, Far Eastern Memorial Hospital, New Taipei City.,4 Department of Industrial Management, Oriental Institute of Technology, New Taipei City.,5 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei
| | - Chia-Der Chao
- 6 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Jenq-Wen Huang
- 6 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Kuan-Yu Hung
- 6 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
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