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Birinci M, Hakyemez ÖS, Korkmaz O, Bingöl İ, Ata N, Ülgü MM, Birinci Ş, Ayvalı MO, Başarır K, Azboy İ. Unseen Threefold Mortality After the First Ten Days in Hemodialysis Patients Following Joint Arthroplasty: A Nationwide Retrospective Cohort Study of 1,287 Arthroplasty Patients on Hemodialysis. J Arthroplasty 2024; 39:2205-2212. [PMID: 38522803 DOI: 10.1016/j.arth.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons. METHODS Between 2016 and 2022, a study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty. RESULTS The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001). CONCLUSIONS Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored.
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Affiliation(s)
- Murat Birinci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Ömer S Hakyemez
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Oğuzhan Korkmaz
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - İzzet Bingöl
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara Oncology Training and Research Hospital, Health Sciences University, Ankara, Türkiye
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - Mahir M Ülgü
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Mustafa O Ayvalı
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - Kerem Başarır
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Haliç University, İstanbul, Türkiye
| | - İbrahim Azboy
- Department of Orthopaedics and Traumatology, School of Medicine, İstanbul Medipol University, İstanbul, Türkiye
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Zhang Z, Driskill E, Chi J, Gean RP, Cui Q. Total Hip Arthroplasty Outcomes before or after Renal Transplant: A Retrospective Large Cohort Analysis. Clin Orthop Surg 2024; 16:382-389. [PMID: 38827758 PMCID: PMC11130632 DOI: 10.4055/cios23351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 06/04/2024] Open
Abstract
Background While it is known that patients with end-stage renal disease (ESRD) are at an increased risk of complications following total hip arthroplasty (THA), there is a gap in the literature in comparing patients with ESRD to patients who undergo renal transplant (RT) before or after THA. This study is to address this gap by analyzing outcomes of THA in ESRD patients, RT patients, and RT candidates. Methods Using the PearlDiver Mariner database, ESRD patients, RT patients, and RT candidates undergoing primary THA were identified and compared. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. Ninety-day emergency department (ED) visits and inpatient readmission were also documented. Results A total of 7,868 patients were included: 5,092 had ESRD, 2,520 had RT before THA, and 256 were candidates for RT. Compared to patients with ESRD, RT patients demonstrated lower rates of medical complications such as pneumonia (3.61% vs. 5.99%, p = 0.039) and transfusion (4.60% vs. 7.66%, p < 0.001). Additionally, RT patients displayed decreased rates of surgical complications, including wound complications (2.70% vs. 4.22%, p = 0.001), periprosthetic joint infection (PJI) at 1 year (2.30% vs. 4.81%, p < 0.001) and 2 years (2.58% vs. 5.42%, p < 0.001), and aseptic loosening at 2 years (0.79% vs. 1.43%, p = 0.006). Similarly, when compared to RT candidates, RT patients demonstrated a lower incidence of postoperative complications, including 1-year PJI (2.30% vs. 5.08%, p = 0.013), 2-year PJI (2.58% vs. 5.08%, p = 0.028), 1-year aseptic loosening (0.56% vs. 2.73%, p < 0.001), and 2-year aseptic loosening (0.79% vs. 2.73%, p = 0.005). RT patients also had lower rates of ED visits and hospital readmissions. Conclusions Compared to ESRD patients and RT candidates, patients with RT have a significantly lower likelihood of medical complications, PJI, aseptic hardware loosening, ED visits, and hospital readmission. Patients with ESRD on the RT waiting list should delay THA until after RT surgery. For those not eligible for RT, it is vital to take extra precautions to reduce the risk of complications.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Richard P. Gean
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Ahlquist S, Kim ST, Hsiue PP, Upfill-Brown A, Photopoulos C, Stavrakis AI. Renal Transplant Patients Have a Lower Risk of Complications and Mortalities After Total Knee Arthroplasty Compared to Those on Hemodialysis: A Large National Database Study. J Arthroplasty 2023; 38:2336-2341.e1. [PMID: 37236290 DOI: 10.1016/j.arth.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) in end-stage renal disease is associated with complications. Controversy exists whether elective TKA should be performed while patients are on hemodialysis (HD) or following renal transplant (RT). This study compares TKA outcomes in HD versus RT patients. METHODS A national database was retrospectively reviewed using International Classification of Diseases codes to identify HD and RT patients who underwent primary TKA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared using Wald and Chi-squared tests. The primary outcome was in-hospital mortalities while secondary outcomes included quality outcomes and medical/surgical complications. Multivariate regressions were used to determine independent associations. Significance was determined with a 2-tailed P value of .05. There were 13,611 patients who underwent TKA (61.1 HD and 38.9% RT). Patients who had RT were younger, had fewer comorbidities, and more likely to have private insurance. RESULTS The RT patients had a lower rate of mortality (odds ratio (OR) 0.23, P < .01)), complications (OR 0.63, P < .01), cardiopulmonary complications (OR 0.44, P = .02), sepsis (OR 0.22, P < .001), and blood transfusion (OR 0.35, P < .001) during the index hospitalization. This cohort was also found to have decreased length of stay (-2.0 days, P < .001), non-home discharge (OR 0.57, P < .001), and hospital cost (-$5,300, P < .001). Patients who had RT had a lower rate of readmission (OR 0.54, P < .001), periprosthetic joint infection (OR 0.50, P < .01), and surgical site infection (OR 0.37, P < .001) within 90 days. CONCLUSION These findings suggest that HD patients are a high-risk population in TKA compared to RT patients and warrant stringent perioperative monitoring.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - Samuel T Kim
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
| | | | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
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Karczewski D, Salmons HI, Leung N, Larson DR, Berry DJ, Abdel MP. Primary Total Hip Arthroplasty in Dialysis-Dependent Patients: 35% Mortality at 5 years. J Arthroplasty 2023; 38:2159-2163. [PMID: 37172793 PMCID: PMC10653652 DOI: 10.1016/j.arth.2023.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Limited knowledge exists on contemporary results of primary total hip arthroplasty (THA) in dialysis-dependent patients. We sought to analyze the mortality rates and cumulative incidences of any revision or reoperation in dialysis-dependent patients undergoing primary THAs. METHODS We identified 24 dialysis-dependent patients who underwent 28 primary THAs between 2000 and 2019 using our institutional total joint registry. Mean age was 57 years (range, 32 to 86), with 43% being women and mean body mass index was 31 (range, 20 to 50). The leading cause for dialysis was diabetic nephropathy (18%). The mean preoperative creatinine and glomerular filtration rate were 6 mg/dL and 13 mL/min, respectively. Kaplan-Meier survivorship methods and a competing risk analysis using death as the competing risk were performed. The mean follow-up was 7 years (range, 2 to 15). RESULTS The 5-year survivorship free from death was 65%. The 5-year cumulative incidence of any revision was 8%. There were a total of 3 revisions as follows: 2 for aseptic loosening of the femoral component and one for a Vancouver B2 fracture. The 5-year cumulative incidence of any reoperation was 19%. There were 3 additional reoperations, and all were irrigation and debridement. Postoperative creatinine and glomerular filtration rate were 6 mg/dL and 15 mL/min, respectively. At a mean of 2 years after THA, 25% successfully received a renal transplant. CONCLUSIONS Dialysis-dependent patients undergoing primary THAs had high 5-year mortality (35%) but an acceptably low cumulative incidence of any revision. While renal metrics remained consistent after THA, only one in 4 patients underwent successful renal transplant. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Harold I. Salmons
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Nelson Leung
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Dirk R. Larson
- Department of Quantitative Health Sciences (QHS), Division of Clinical Trials and Biostatistics (CTB), Mayo Clinic, 200 First Street SW, Rochester, MN 559056
| | - Daniel J. Berry
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Luo Y, Gong J, Yang S. Knee and hip arthroplasty joint surgical site wound infection in end-stage renal disease subjects who underwent dialysis or a kidney transplant: A meta-analysis. Int Wound J 2023; 20:2811-2819. [PMID: 37038328 PMCID: PMC10410356 DOI: 10.1111/iwj.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/12/2023] Open
Abstract
A meta-analysis study to assess the knee and hip arthroplasty joint surgical site wound infection (SSWI) in end-stage renal disease (ESRD) subjects who underwent dialysis or a kidney transplant (KT). A comprehensive literature examination till February 2023 was implemented and 1046 linked studies were appraised. The picked studies contained 5 471 898 subjects with total joint arthroplasty (TJA) at the baseline, 13 049 of them were haemodialysis or renal transplant, and 5 458 849 were control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of knee and hip arthroplasty SSWI in ESRD subjects who underwent dialysis or a KT by the dichotomous and continuous styles and a fixed or random model. Haemodialysis or renal transplant had a significantly higher postoperative SSWI (OR, 2.13; 95% CI, 1.73-2.62, P < .001) compared with control in TJA subjects. However, no significant difference was observed between haemodialysis and renal transplant in postoperative SSWI (OR, 0.93; 95% CI, 0.16-5.54, P = .94) and between haemodialysis or renal transplant and control in prosthetic joint infection (OR, 1.07; 95% CI, 0.25-4.55, P = .93) in TJA subjects. Haemodialysis had a significantly higher prosthetic joint infection (OR, 1.92; 95% CI, 1.21-3.03, P = .005) compared with renal transplant in TJA subjects. Haemodialysis or renal transplant had a significantly higher postoperative SSWI in TJA subjects. Also, haemodialysis had a significantly higher prosthetic joint infection compared with renal transplant in TJA subjects. Although precautions should be taken when commerce with the consequences because a low number of selected studies was picked for certain comparisons in this meta-analysis.
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Affiliation(s)
- Yankun Luo
- Department of NephrologyShanxi Provincial People's HospitalTaiyuanShanxi030012China
| | - Junfeng Gong
- Department of NephrologyThe Fifth Clinical College of Shanxi Medical UniversityJinzhongShanxi030012China
| | - Shuyuan Yang
- Department of NephrologyThe Fifth Clinical College of Shanxi Medical UniversityJinzhongShanxi030012China
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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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Lee R, Lee D, Heyer JH, Richards S, Hughes AJ, Schumer GB, Shincovich CI, Pandarinath R. Hip hemiarthroplasty for the treatment of femoral neck fractures in dialysis patients. Hip Int 2023; 33:338-344. [PMID: 34311615 DOI: 10.1177/11207000211028151] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to delineate the postoperative outcomes in dialysis patients undergoing hip hemiarthroplasty (HHA) for the treatment of femoral neck fractures (FNF) in order to better optimise pre- and postoperative management and minimise short-term morbidity and mortality rates. METHODS 16,955 patients who had undergone HHA for femoral neck fractures from 2005 to 2018 were isolated from a multi-institutional surgical registry, of which 343 (2.0%) were on dialysis and 16,612 (98.0%) were not. The cohorts were identified/analysed for differences in their comorbidities, demographic factors, and 30-day postoperative complications using Fischer's exact tests and Mann-Whitney U-tests. Coarsened exact matching (CEM) was implemented in order to control for baseline difference in demographics and comorbidities. Multivariate logistic regression analyses were used to assess the impact of dialysis as an independent risk factor for various complications, including reoperations, readmissions, and mortality. RESULTS Upon CEM-matching (L1-statistic <0.001), weighted multivariate logistic regression analyses demonstrated dialysis to be an independent risk factor for minor complications (OR 3.051, p < 0.001), pneumonia (OR 3.943, p < 0.001), urinary tract infections (UTIs) (OR 2.684, p < 0.001), major complications (OR 1.892, p < 0.001), unplanned intubation (OR 2.555, p = 0.047), cardiac arrest (OR 11.897, p < 0.001), deep vein thrombosis (DVT), (OR 2.610, p = 0.049), and mortality (OR 2.960, p < 0.001). CONCLUSIONS Dialysis independently increased the risk for unplanned intubation, cardiac arrest, blood transfusions, pneumonia, DVT, and mortality. In communicating postoperative expectations, surgeons should aim to clarify the patients' preferences and potential resuscitation designations prior to surgical intervention due to the increased risk of serious complications. A lower threshold of suspicion for DVT in this population is reasonable. Identifying high-risk patient populations that may experience increased rates of complications, with the ensuing financial expenditures, due to medical complexity rather than subpar management may help providers avoid penalties in caring for these patients.
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Affiliation(s)
- Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Jessica H Heyer
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Richards
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alice J Hughes
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Grace B Schumer
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Christina I Shincovich
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
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Khanna V, Sakthivelnathan V, Senthil T, Varatharaj S, Mounasamy V, Sambandam S. Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients. Indian J Orthop 2023; 57:336-343. [PMID: 36777113 PMCID: PMC9880083 DOI: 10.1007/s43465-022-00799-x] [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: 07/24/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Purpose The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients. Methods The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016-2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016-2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications. Results Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3 days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility. Conclusions This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk-benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.
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Affiliation(s)
- Vishesh Khanna
- Trauma and Orthopaedics, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, USA
- Orthopedics, Dallas VAMC, Dallas, TX USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, USA
- Orthopedics, Dallas VAMC, Dallas, TX USA
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Ahlquist S, Kim ST, Hsiue PP, Benharash P, Ponzio DY, Photopoulos C, Zeegen EN, Stavrakis AI. Comparison of total hip arthroplasty outcomes between hemodialysis and renal transplant patients. Hip Int 2022:11207000221091994. [PMID: 35437061 DOI: 10.1177/11207000221091994] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) in end-stage renal disease (ESRD) patients is associated with increased complications. Controversy exists whether elective THA should be performed while these patients are on haemodialysis (HD) or following renal transplant (RT). This study seeks to compare THA outcomes in HD versus RT patients. METHODS A national database was retrospectively reviewed using ICD codes to identify all HD and RT patients who underwent primary THA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared between cohorts using Wald and chi-square tests. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), non-home discharge, cost, readmission, and medical/surgical complications. Multivariate regression was used to determine independent associations. Significance was determined with a 2-tailed p-value of 0.05. RESULTS 11,133 patients underwent THA, 61.6% HD and 39.4% RT patients. RT patients were younger, had fewer comorbidities, and more likely to have private insurance. After adjusting for these differences, RT patients had a lower rate of mortality (OR 0.31, p = 0.01), complications (OR 0.54, p < 0.01), cardiopulmonary complications (OR 0.54, p = 0.04), sepsis (OR 0.43, p < 0.01), and blood transfusion (OR 0.39, p < 0.001) during the index hospitalisation. RT was associated with decreased LOS (-2.0 days, p < 0.001), non-home discharge (OR 0.35, p < 0.001), and hospital cost (-$6,000, p < 0.001). RT had a lower rate of readmission (OR 0.60, p < 0.001) and revision surgery (OR 0.24, p = 0.01) within 90 days. CONCLUSIONS These findings suggest HD patients are a high-risk population in THA compared to RT patients and warrant stringent perioperative monitoring.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Samuel T Kim
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Peyman Benharash
- Department of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Danielle Y Ponzio
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Erik N Zeegen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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10
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Hoggard TM, Chen DQ, Quinlan ND, Bell JE, Werner BC, Cui Q. Outcomes Following Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients on Hemodialysis. J Bone Joint Surg Am 2022; 104:90-94. [PMID: 35389908 DOI: 10.2106/jbjs.20.00352] [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: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a potentially debilitating condition, often requiring total hip arthroplasty (THA). Patients on hemodialysis (HD) are at increased risk for complications after THA for osteoarthritis, however there is limited information on outcomes of THA for ONFH in patients on HD. With increasing prevalence of chronic kidney disease (CKD) requiring HD, studies are needed to characterize the risk of complications in these patients. Therefore, the purpose of this study was to evaluate HD as a potential risk factor for complication after THA in patients with ONFH on HD. METHODS Patients on HD with ONFH who underwent THA with at least 2 years of follow-up were identified using a combination of ICD-9 and CPT codes in a national insurance database. A 10:1 matched control cohort of patients with ONFH not on HD was created for comparison. A logistic regression analysis was used to evaluate rates of death, hospital readmission, emergency room (ER) visit, infection, revision, and dislocation between cohorts. Differences in hospital charges, reimbursement, and length of stay between the two groups were also assessed. RESULTS One thousand one hundred thirty-seven patients on HD who underwent THA for ONFH were compared to a matched control cohort of 11,182 non-HD patients who underwent THA for ONFH. Patients on HD experienced higher rates of death (HD 4.1%, non-HD 0.9%; odds ratio [OR] 3.35, p < 0.01), hospital readmission (HD 16.1%, non-HD 5.9%; OR 2.69, p < 0.01) and ER visit (HD 10.4%, non-HD 7.4% OR 1.5, p < 0.01). Hemodialysis was not associated with higher risk of infection, revision, or dislocation, but was associated with significantly higher charges (p < 0.01), reimbursement (p < 0.01), and hospital length of stay (p < 0.01). CONCLUSIONS While patients on HD do not have increased risk of implant-related complications, they are at increased risk of developing medical complications following THA for ONFH and subsequently may require more resources. Orthopedic surgeons and nephrologists should be cognizant of the increased risk in this population to provide appropriate preoperative counseling and enhanced perioperative medical management. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Timothy M Hoggard
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia
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11
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Buitrago G, Ortiz JR, Camacho F. Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data. J Knee Surg 2022; 35:384-392. [PMID: 32838453 DOI: 10.1055/s-0040-1715097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299-7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.
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Affiliation(s)
- Giancarlo Buitrago
- Department of Surgery, Clinical Research Institute, Universidad Nacional de Colombia, Bogota, DC, Colombia.,Department of Surgery, Hospital Universitario Nacional de Colombia, Bogotá, DC, Colombia
| | - Jorge R Ortiz
- Department of Surgery, Hospital Universitario Nacional de Colombia, Bogotá, DC, Colombia.,Orthopedics and Traumatology Unit, Department of Surgery, Universidad Nacional de Colombia, Bogota, DC, Colombia
| | - Felipe Camacho
- Department of Surgery, Hospital Universitario Nacional de Colombia, Bogotá, DC, Colombia.,Orthopedics and Traumatology Unit, Department of Surgery, Universidad Nacional de Colombia, Bogota, DC, Colombia
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12
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Harvey JP, Foy MP, Sood A, Gonzalez MH. Unplanned intubation after total hip and total knee arthroplasty: Assessing preoperative risk factors. J Orthop 2022; 29:86-91. [PMID: 35210717 PMCID: PMC8844728 DOI: 10.1016/j.jor.2022.01.011] [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: 10/01/2021] [Revised: 01/17/2022] [Accepted: 01/29/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The purpose of this study is to assess preoperative patient attributes as risk factors for unplanned intubation after primary total knee and total hip arthroplasty. METHODS This was a retrospective analysis of data collected from the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) who experienced postoperative intubation were included in the study. A multivariate regression was used to assess preoperative characteristics as risk factors for postoperative intubation. RESULTS Multivariate regression determined that perioperative transfusion of packed RBC's, cardiac comorbidities, patients older than 73, dyspnea with moderate exertion, dyspnea while at rest, diabetes mellitus requiring medical therapy, pulmonary comorbidities, current dialysis usage, body mass index greater than 29.9, and current smoker within the last year were variables associated with an increased risk of unplanned intubation after THA. Additionally, multivariate regression determined that anemia, perioperative transfusion of packed RBC's, cardiac comorbidities, patients older than 73, dyspnea with moderate exertion, diabetes mellitus requiring medical therapy, pulmonary comorbidities, and current dialysis usage were associated with unplanned intubation after TKA. CONCLUSION This study identifies numerous risk factors for intubation after THA or TKA.
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Affiliation(s)
- Jackson P. Harvey
- Corresponding author. Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue, E270 MSS MC 844, Chicago, IL, 60612, USA.
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13
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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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14
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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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15
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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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16
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Preoperative risk factors for postoperative cardiac arrest following primary total hip and knee arthroplasty: A large database study. J Clin Orthop Trauma 2021; 16:244-248. [PMID: 33717961 PMCID: PMC7920110 DOI: 10.1016/j.jcot.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cardiac arrest (CA) has been identified as a potential complication following Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). This retrospective, case-controlled study aims to identify risk factors in order to improve the management of patients undergoing THA or TKA with known preoperative comorbidities. METHODS CPT codes were used to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent THA or TKA from 2010 to 2017. Patients were classified as having cardiac arrest (CA) by the NSQIP guidelines. Patient samples with all possible covariates were included for the multivariate logistic regression analysis and assessed for independent association. RESULTS Patients receiving perioperative transfusion, experiencing dyspnea with moderate exertion, dyspnea at rest, patients currently on dialysis, and patients aged ≥72 are all independently associated with increased rates of cardiac arrest (CA) following THA. Patients receiving perioperative transfusion, patients with anemia, bleeding disorders, dyspnea with moderate exertion, cardiac comorbidities, pulmonary comorbidities, and patients aged ≥73 are all associated with increased rates of cardiac arrest (CA) following TKA. CONCLUSION Patients with the identified risk factors are at a greater risk of suffering cardiac arrest within 30 days following THA and TKA. It is imperative that we recognize which risk factors may precipitate CA in THA and TKA recipients so that prophylactic management can be employed. Furthermore, management guidelines should be updated for patients at high risk of CA following THA and TKA to prevent this complication.
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17
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Gould D, Dowsey MM, Spelman T, Jo O, Kabir W, Trieu J, Bailey J, Bunzli S, Choong P. Patient-Related Risk Factors for Unplanned 30-Day Hospital Readmission Following Primary and Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:E134. [PMID: 33401763 PMCID: PMC7795505 DOI: 10.3390/jcm10010134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023] Open
Abstract
Total knee arthroplasty (TKA) is a highly effective procedure for advanced osteoarthritis of the knee. Thirty-day hospital readmission is an adverse outcome related to complications, which can be mitigated by identifying associated risk factors. We aimed to identify patient-related characteristics associated with unplanned 30-day readmission following TKA, and to determine the effect size of the association between these risk factors and unplanned 30-day readmission. We searched MEDLINE and EMBASE from inception to 8 September 2020 for English language articles. Reference lists of included articles were searched for additional literature. Patients of interest were TKA recipients (primary and revision) compared for 30-day readmission to any institution, due to any cause, based on patient risk factors; case series were excluded. Two reviewers independently extracted data and carried out critical appraisal. In-hospital complications during the index admission were the strongest risk factors for 30-day readmission in both primary and revision TKA patients, suggesting discharge planning to include closer post-discharge monitoring to prevent avoidable readmission may be warranted. Further research could determine whether closer monitoring post-discharge would prevent unplanned but avoidable readmissions. Increased comorbidity burden correlated with increased risk, as did specific comorbidities. Body mass index was not strongly correlated with readmission risk. Demographic risk factors included low socioeconomic status, but the impact of age on readmission risk was less clear. These risk factors can also be included in predictive models for 30-day readmission in TKA patients to identify high-risk patients as part of risk reduction programs.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
- Department of Othopaedics, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Olivia Jo
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Wassif Kabir
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Jason Trieu
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - James Bailey
- School of Computing and Information Systems, University of Melbourne, 3052 Melbourne, Australia;
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Peter Choong
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
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18
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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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Zhu Y, Hu J, Han W, Lu J, Zeng Y. Simultaneous bilateral femoral neck fractures in a dialysis-dependent patient: case report and literature review. BMC Musculoskelet Disord 2020; 21:242. [PMID: 32293406 PMCID: PMC7158116 DOI: 10.1186/s12891-020-03281-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Simultaneous bilateral femoral neck fractures are extremely rare without obvious injury. Herein, we report the case of a patient on dialysis presenting with bilateral femoral neck fractures, which is a condition with high complication and mortality rates according to a review of the pertinent literature. CASE PRESENTATION We report the case a 47-year-old female with a history of 8 years of haemodialysis due to polycystic kidney disease who presented with bilateral hip pain during walking. The clinical history and results of physical and radiographic examinations of this patient are shown. Single-stage bilateral hemiarthroplasty was performed after a multidisciplinary team consultation. Three days after the operation, she could ambulate with a walker. The woman gradually regained her previous ability to walk over 6 months after surgery. CONCLUSIONS A multidisciplinary team consultation for perioperative management is necessary and effective in patients on dialysis. Early diagnosis with prompt surgical treatment could lead to favourable recovery.
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Affiliation(s)
- Yunyun Zhu
- Department of Nephrology, Tongde Hospital of Zhejiang Province, HangZhou, Zhejiang Province, China
| | - Jingtao Hu
- Zhejiang Chinese Medical University, HangZhou, Zhejiang Province, China
| | - Wenlun Han
- Department of Nephrology, Tongde Hospital of Zhejiang Province, HangZhou, Zhejiang Province, China
| | - Jianwei Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 GuCui Road, HangZhou, 310012, Zhejiang Province, China
| | - Yuqing Zeng
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 GuCui Road, HangZhou, 310012, Zhejiang Province, China.
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20
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Kim CW, Kim HJ, Lee CR, Wang L, Rhee SJ. Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis. Knee Surg Relat Res 2020; 32:12. [PMID: 32660587 PMCID: PMC7219208 DOI: 10.1186/s43019-020-0029-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group). METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group). RESULTS Eighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group. CONCLUSIONS Preoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.
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Affiliation(s)
- Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Lih Wang
- Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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21
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Gould D, Dowsey M, Jo I, Choong P. Patient-related risk factors for unplanned 30-day readmission following total knee arthroplasty: a narrative literature review. ANZ J Surg 2020; 90:1253-1258. [PMID: 31970878 DOI: 10.1111/ans.15695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022]
Abstract
Osteoarthritis is a debilitating condition as well as a growing global health problem, and total knee arthroplasty (TKA) is an effective treatment for advanced disease. Unplanned 30-day hospital readmission is an indicator of complications, which is a significant financial burden on healthcare systems. We reviewed the literature to better understand the patient-related factors associated with unplanned 30-day readmission following TKA. MEDLINE and EMBASE were searched for studies reporting on patient-related risk factors for unplanned 30-day readmission following primary or revision TKA for any indication. The impact of specific medical comorbidities on increasing the risk of 30-day readmission following TKA is quite well established. The following comorbidities are strongly associated with readmission: bleeding disorder, diabetes, chronic kidney disease and dialysis, chronic immunosuppressant use and history of cancer. Other significant comorbidities include: dementia; depression; haematological (coagulopathy and anaemia), cardiovascular (atrial fibrillation, cardiovascular disease, coronary artery disease and congestive heart failure), respiratory (chronic obstructive pulmonary disease) and liver diseases; and cerebrovascular accident/transient ischaemic attack (but only in revision TKA patients). The influence of variation in sex, age and body mass index each demonstrate a more complex pattern. A systematic review and meta-analysis is required to quantify the impact of the various patient-related factors on 30-day readmission following TKA. Clinicians can use this information in preoperative decision-making.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Othopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Imkyeong Jo
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Othopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
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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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23
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Affiliation(s)
- Mengnai Li
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Andrew Glassman
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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