TY - JOUR
T1 - Impact of Chronic Kidney Disease in Older Adults Undergoing Hip or Knee Arthroplasty
T2 - A Large Database Study
AU - Antoniak, Derrick T.
AU - Benes, Brian J.
AU - Hartman, Curtis W.
AU - Vokoun, Chad W.
AU - Samson, Kaeli K.
AU - Shiffermiller, Jason F.
N1 - Funding Information:
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program are the source of the data used herein. They have not verified, nor are they responsible, for the statistical validity of the data analysis or the conclusions derived by the authors. The interpretation and reporting of data supplied by the United States Renal Data System (USRDS) [41] are the responsibility of the authors and in no way shold be seen as an official policy or interpretation of the U.S. government. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019
PY - 2020/5
Y1 - 2020/5
N2 - Background: Hip and knee arthroplasties are among the most commonly performed surgical procedures in the elderly. In this age group, uncertainty exists regarding the importance of mild to moderate chronic kidney disease (CKD), which is prevalent but often unrecognized in the perioperative setting. This study evaluates the association between mild to moderate CKD and adverse postoperative outcomes in patients 65 years or older Methods: This retrospective study selected patients 65 years or older undergoing hip or knee arthroplasty between 2006 and 2016 from the National Surgical Quality Improvement Program database. We created logistic regression models to analyze the relationship between CKD stage and each of our coprimary outcomes. The primary outcomes were major complication and mortality occurring within 30 days of surgery. Results: Of the 193,747 included patients, 68,424 (35.3%) underwent hip and 125,323 (64.7%) knee arthroplasty. Within 30 days of surgery, 12,767 patients (6.6%) experienced a major complication and 352 (0.2%) died. Compared to patients with no kidney disease, patients with CKD stages 3b and 4 were at higher risk for both major complication (adjusted odds ratio [aOR] 1.28 [1.08-1.52], aOR 1.5 [1.13-1.98], respectively) and mortality (aOR 3.17 [1.23-8.14], aOR 3.93 [1.26-12.21], respectively) after hip arthroplasty, and for major complication (aOR 1.42 [1.23-1.63], aOR 1.52 [1.19-1.93], respectively) after knee arthroplasty. Conclusion: Among elderly patients, stage 3b and stage 4 CKD were associated with 30-day postoperative major complication after hip or knee arthroplasty, and with 30-day postoperative mortality after hip, but not knee, arthroplasty. Further research will be required to inform perioperative management decisions.
AB - Background: Hip and knee arthroplasties are among the most commonly performed surgical procedures in the elderly. In this age group, uncertainty exists regarding the importance of mild to moderate chronic kidney disease (CKD), which is prevalent but often unrecognized in the perioperative setting. This study evaluates the association between mild to moderate CKD and adverse postoperative outcomes in patients 65 years or older Methods: This retrospective study selected patients 65 years or older undergoing hip or knee arthroplasty between 2006 and 2016 from the National Surgical Quality Improvement Program database. We created logistic regression models to analyze the relationship between CKD stage and each of our coprimary outcomes. The primary outcomes were major complication and mortality occurring within 30 days of surgery. Results: Of the 193,747 included patients, 68,424 (35.3%) underwent hip and 125,323 (64.7%) knee arthroplasty. Within 30 days of surgery, 12,767 patients (6.6%) experienced a major complication and 352 (0.2%) died. Compared to patients with no kidney disease, patients with CKD stages 3b and 4 were at higher risk for both major complication (adjusted odds ratio [aOR] 1.28 [1.08-1.52], aOR 1.5 [1.13-1.98], respectively) and mortality (aOR 3.17 [1.23-8.14], aOR 3.93 [1.26-12.21], respectively) after hip arthroplasty, and for major complication (aOR 1.42 [1.23-1.63], aOR 1.52 [1.19-1.93], respectively) after knee arthroplasty. Conclusion: Among elderly patients, stage 3b and stage 4 CKD were associated with 30-day postoperative major complication after hip or knee arthroplasty, and with 30-day postoperative mortality after hip, but not knee, arthroplasty. Further research will be required to inform perioperative management decisions.
KW - chronic kidney disease
KW - elderly
KW - postoperative complications
KW - total hip arthroplasty
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85077731256&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85077731256&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2019.12.040
DO - 10.1016/j.arth.2019.12.040
M3 - Article
C2 - 31948811
AN - SCOPUS:85077731256
SN - 0883-5403
VL - 35
SP - 1214-1221.e5
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 5
ER -