Total hip arthroplasty complications in patients with chronic kidney disease: A comparison study
Jake A Fox1, Grayson A Domingue2, Christian V DeMaio3
1Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
Insights
Patients with end-stage renal disease (ESRD) and chronic kidney disease (CKD) face higher complication rates after total hip arthroplasty (THA). This study highlights increased risks for ESRD and CKD patients undergoing THA, aiding surgical planning.
Area of Science:
- Orthopaedic Surgery
- Nephrology
- Public Health
Background:
- Existing literature suggests elevated complication rates following total hip arthroplasty (THA) in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD).
- Limited data exists comparing THA outcomes between osteoarthritis (OA) patients and those with CKD/ESRD and OA.
Purpose of the Study:
- To analyze the risk of postoperative complications after THA in CKD and ESRD populations, stratified by disease stage.
- To compare these risks against a control group of OA patients.
- To provide orthopaedic providers with data for improved patient care and preoperative planning.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2006-2015.
- Identified patients undergoing elective THA with diagnoses of OA, ESRD, and CKD.
- Examined preoperative comorbidities and categorized postoperative complication incidence.
Main Results:
- Analysis of 4,350,961 OA, 8,355 ESRD, and 104,313 CKD patients undergoing THA.
- ESRD patients exhibited significantly higher rates of wound hematoma, infection, cardiac, urinary, and pulmonary complications compared to OA patients.
- CKD patients (stages 3-5) also showed significantly higher rates in multiple complication categories compared to OA patients.
Conclusions:
- Patients with ESRD and CKD experience increased complication rates after THA.
- Stage-specific complication data can enhance preoperative planning for orthopaedic surgeons.
- Findings support informed decision-making regarding bundled reimbursement for high-risk patient populations.
Background:
It has been noted in the literature that there are increased complication rates following total hip arthroplasty (THA) in patients with chronic kidney disease (CKD) or end stage renal disease (ESRD). However, there is little data directly comparing outcomes in patients undergoing THA for osteoarthritis (OA) versus ESRD or CKD with OA. The objective of this study is to illustrate the risk of developing postoperative complications after THA in the CKD and ESRD populations by stage of disease when compared to a control group (OA) and thus better equip orthopaedic providers in the care of these patients.
Methods:
The National Inpatient Sample (NIS) was utilized to identify patients undergoing elective THA from 2006 to 2015 with OA, ESRD, and CKD. The prevalence of preoperative comorbidities and the incidence of numerous postoperative complications broken into categories were examined.
Results:
Between 2006 and 2015 the NIS database reported 4,350,961 patients diagnosed with OA, 8355 diagnosed with ESRD, and 104,313 diagnosed with CKD undergoing THA. The incidence of wound hematoma (2.5% vs. 0.8%; p < .0001), wound infection (0.7% vs. 0.4%; p = .0319), cardiac (1.3% vs. 0.6%; p = .0067), urinary (3.9% vs. 2.0%; p < .0001), and pulmonary complications (2.2% vs. 0.5%; p < .0001) occurred more frequently in patients with OA and ESRD when compared to only OA patients. For patients with OA and CKD, stages 3-5 saw at least half of the complication categories occur at significantly higher rates than OA patients.
Conclusion:
This study shows that patients with ESRD and CKD have increased rates of complications after THA. This study's specific breakdown by stage and complication can benefit orthopaedic surgeons and practitioners in realistic pre and postoperative planning and provides data that could benefit decision making on bundled reimbursement for this specific patient population, as providers could better account for the postoperative complications noted above and their associated costs.
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