Abstract
Background
Chronic kidney disease (CKD) is a relatively common comorbidity that has been shown
to adversely affect outcomes in total hip arthroplasty (THA), as well as to increase
the procedure's total costs. However, the effect of different stages of kidney disease
and the association of estimated glomerular filtration rate (eGFR) with perioperative
THA complications are less understood. Therefore, the aims of this study were to investigate
the relationships between eGFR, both as a categorical and continuous variable and
30-day outcomes and complications.
Methods
The National Surgical Quality Improvement Program database was used to identify 101,925
primary THAs between January 1, 2008, and December 31, 2016. The following outcomes
were assessed: 30-day mortality, 30-day major complications, 30-day minor complications,
specific complications, and discharge disposition. To evaluate the effect of eGFR
status on outcomes and complication, multivariate regression models were created to
adjust for differences in patient demographics and comorbidities. In addition, multivariate
spline regressions were developed to assess the nonlinear relationships between eGFR
as a continuous variable and the outcomes of interest.
Results
Our study revealed that as eGFR decreases to <30 mL/min/1.73 m2, there is an increased risk for mortality and nonhome discharge (P < .05). There was an increased risk for any major complication and any minor complication
as well as several specific medical complications such as transfusion and myocardial
infarction (P < .05) for an eGFR of <60 mL/min/1.73 m2. Patients' eGFR had a nonlinear relationship with mortality (P = .0001), any major complication (P < .001), and any minor complication (P < .001), as well as a number of other specific medical complications. Once the eGFR,
<60 mL/min/1.73 m2 the increase was exponential for mortality, major complications, and minor complications.
For example, mortality increased of 900% for <15 mL/min/1.73 m2 or on dialysis, 600% for 15 to 30 mL/min/1.73 m2 and 50% for 30 to 60 mL/min/1.73 m2. Similarly, nonlinear relationships were discovered between eGFR and nonhome discharge
(P < .001).
Conclusion
Patients with lower eGFR, and in particular those with <30 mL/min/1.73 m2, are more likely to sustain medical complications and have 6 to 9 times higher mortality
than patients with normal eGFR. THA patients with CKD should be appropriately counseled
and advised on the risk of postoperative complications by using eGFR as a screening
tool.
Keywords
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Article Info
Publication History
Published online: October 09, 2019
Accepted:
October 1,
2019
Received in revised form:
October 1,
2019
Received:
September 3,
2019
Footnotes
Financial Support: No financial support was used for the conductance of this study.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.10.001.
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© 2019 Elsevier Inc. All rights reserved.
