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Published on: May 20, 2019
Effect of kidney function on 30 day post-operative complications and mortality following ankle fracture ORIF
Paul Pottanat1, Carson McKoon1, Joshua Morningstar1
1Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas St., CSB 708, Charleston, SC 29425, United States.
Background:
Estimated glomerular filtration rate (eGFR) is commonly used to evaluate kidney function before surgery, but research on its impact on outcomes after ankle fracture open reduction and internal fixation (ORIF) is limited. This study aims to analyze how eGFR affects short-term complications and mortality following ankle fracture ORIF.
Methods:
The American College of Surgeons (ACS) NSQIP database was queried from 2005 to 2019 to identify 44,755 patients who underwent ankle fracture ORIF using specific CPT codes. Patients were excluded for missing demographic data or preoperative eGFR exceeding 3 standard deviations above the mean (91.1 mL/min/1.73 m²). Patients were categorized by eGFR: end stage renal disease (ESRD) (<15 mL/min/1.73 m2 [1.39 %]), severe loss of kidney function (15-30 mL/min/1.73 m2 [2.32 %]), moderate loss of kidney function (30-60 mL/min/1.73 m2 [15.45 %]), mild loss of kidney function (60-90 mL/min/1.73 m2 [33.78 %]), normal kidney function (90-120 mL/min/1.73 m2 [29.47 %]), and hyperfiltration (>120 mL/min/1.73 m2 [17.57 %]). Demographics, hospital length of stay, 30-day complications, surgical site infections (SSI), Clavien-Dindo grade IV complications, readmissions, reoperations, and mortality rates were compared. The cohort was primarily female (64.5 %), with a mean age of 55.41 years (range, 16-89).
Results:
A total of 21,815 patients were included, with about 30 % having an eGFR of 90-120 mL/min/1.73 m², indicating "normal" kidney function. As eGFR decreased, patient age (p < .001), BMI (p < .001), female sex rate (p < .001), and comorbidities significantly increased. Multivariate regression analysis showed that compared to normal eGFR (>90), patients with ESRD or moderate to severe kidney loss had a significantly higher risk of complications (ESRD: OR=1.576; p = .028)(15-30: 1.978; p < .001), reoperation (ESRD: OR=1.872; p = .039)(30-60: 1.523; p = .012), and readmission (ESRD: OR=1.784; p = .013)(30-60: 1.389; p = .012).
Conclusion:
In patients undergoing ankle fracture ORIF, worse kidney function, as indicated by eGFR, was significantly linked to higher rates of postoperative complications, reoperation, and readmission. Surgeons and patients should take these findings into account for those with reduced kidney function.
Level Of Evidence:
Level III, Retrospective Cohort Study.
