Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications
0
조회
0
다운로드
0
인용
0
참고문헌
초록
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.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. 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. 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.
Abstract
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.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. 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. 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.
참고문헌 (20)
- Saran R, "US renal data system 2016annual data report : epidemiology of kidney disease in the United States", Am J Kidney Dis, 69(3), pp.A7~A8 (2017)[DOI]
- "Chronic Kidney Disease in the United States" (2021)[URL]
- Kii S, "Mid-term clinical outcomes and complications of primary total knee arthroplasty in hemodialysis patients : a retrospective comparative cohort study", BMC Musculoskelet Disord, 22(1), pp.927~ (2021)[DOI]
- Singh JA, "Rates of total joint replacement in the United States : future projections to 2020–2040 using the national inpatient sample", J Rheumatol, 46(9), pp.1134~1140 (2019)[DOI]
- "Patient education: total knee replacement (Beyond the Basics)—UpToDate" (2022)[URL]
- Yen SH, "Perioperative complications of total knee arthroplasty in dialysis patients", J Arthroplasty, 33(3), pp.872~877 (2018)[DOI]
- Ponnusamy KE, "Inpatient mortality and morbidity for dialysis-dependent patients undergoing primary total hip or knee arthroplasty", J Bone Joint Surg Am, 97(16), pp.1326~1332 (2015)[DOI]
- Gkiatas I, "Total knee arthroplasty in dialysis patients: is it safe? A systematic review of the literature", J Orthop, 25, pp.199~206 (2021)[DOI]
- Casqueiro J, "Infections in patients with diabetes mellitus: a review of pathogenesis", Indian J Endocrinol Metab, 16(Suppl 1), pp.27~36 (2012)[DOI]
- "CDC Newsroom" (2016)[URL]
- Szeto CC, "Peritoneal dialysis-related infection in the older population", Perit Dial Int, 35(6), pp.659~662 (2015)[DOI]
- Lee SH, "Outcome and cost analysis of primary total knee arthroplasty in end-stage renal disease patients : a nationwide population-based study", Biomed J, 44(5), pp.620~626 (2021)[DOI]
- Patterson JT, "Dialysis dependence predicts complications, intensive care unit care, length of stay, and skilled nursing needs in elective primary total knee and hip arthroplasty", J Arthroplasty, 33(7), pp.2263~2267 (2018)[DOI]
- Batchelor EK, "Iron deficiency in chronic kidney disease : updates on pathophysiology, diagnosis, and treatment", JASN, 31(3), pp.456~468 (2020)[DOI]
- Ottesen TD, "Dialysis dependence is associated with significantly increased odds of perioperative adverse events after geriatric hip fracture surgery even after controlling for demographic factors and comorbidities", JAAOS Glob Res Rev, 3(8), pp.e086~ (2019)[DOI]
- Molnar AO, "The risk of major hemorrhage with CKD", JASN, 27(9), pp.2825~2832 (2016)[DOI]
- Baaten CCFMJ, "Platelet function in CKD : a systematic review and meta-analysis", JASN, 32(7), pp.1583~1598 (2021)[DOI]
- Jain N, "Role of platelets in chronic kidney disease", JASN, 32(7), pp.1551~1558 (2021)[DOI]
- "2020 Census Illuminates Racial and Ethnic Composition of the Country"[URL]
- Bozic KJ, "Is administratively coded comorbidity and complication data in total joint arthroplasty valid?", Clin Orthop Relat Res, 471(1), pp.201~205 (2013)[DOI]