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|Title:||Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty|
|Authors:||Ponnusamy, K E;Jain, A;Thakkar, S C;Sterling, R S;Skolasky, R L;Khanuja, H S|
|Keywords:||*Cause of Death;*Hospital Mortality;Age Factors;Aged;Arthroplasty, Replacement, Hip/methods/*mortality;Arthroplasty, Replacement, Knee/methods/*mortality;Cohort Studies;Confidence Intervals;Databases, Factual;Female;Follow-Up Studies;Human;Kidney Failure, Chronic/diagnosis/mortality/therap;Male;Middle Aged;Odds Ratio;Renal Dialysis/methods/*mortality;Retrospective Studies;Risk Assessment;Sex Factors;Survival Analysis;Treatment Outcome|
|Abstract:||BACKGROUND: Dialysis-dependent patients can develop osteoarthritis or osteonecrosis, warranting hip or knee arthroplasty. Their comorbidities predispose them to complications. Our goal was to determine inpatient outcomes of dialysis-dependent patients after primary elective total hip or knee arthroplasty. METHODS: In the National Inpatient Sample, we identified 2934 dialysis-dependent patients who had undergone total hip or knee arthroplasty from 2000 through 2009 and compared them with 6,186,475 patients who had undergone the same procedures and were not dialysis-dependent. We described demographic characteristics, comorbidities, and outcomes and assessed associations of dialysis status with inpatient mortality and complications. RESULTS: In the hip arthroplasty group, dialysis-dependent patients were younger (63.2 compared with 65.2 years; p = 0.0476) and more commonly diagnosed with osteonecrosis (34.29% compared with 10.94%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (1.88% compared with 0.13%; p < 0.0001) and greater overall complication rates (9.98% compared with 4.97%; p = 0.0001). Dialysis was an independent risk factor for mortality (odds ratio, 6.66; 95% confidence interval [95% CI], 2.66 to 16.66) and complications (odds ratio, 1.53; 95% CI, 1.01 to 2.33). In the knee arthroplasty group, dialysis-dependent patients were similar in age (66.7 compared with 66.8 years; p = 0.8085) and were more commonly diagnosed with osteonecrosis (3.32% compared with 0.74%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (0.92% compared with 0.10%; p < 0.0001) and greater overall complication rates (12.48% compared with 5.00%; p < 0.0001). Dialysis status was an independent risk factor for mortality (odds ratio, 3.31; 95% CI, 1.04 to 10.54) and complications (odds ratio, 1.86; 95% CI, 1.34 to 2.60). CONCLUSIONS: Total hip and knee arthroplasty in dialysis-dependent patients presents high risk, with inpatient mortality rates ten to twenty times greater and overall complication rates two times greater than in non-dialysis-dependent patients. Arthroplasty should be approached with caution and preferably should be delayed until after renal transplantation.|
|More Information:||Volume : 97Issue : 16Start page : 1326|
END PAGES : 1332
|Appears in Collections:||Journal of Bone & Joint Surgery (American Volume)|
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