Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders

Chukwuweike U. Gwam; Assem Sultan; Samuel Rosas; Rashad Sullivan; Michael Seem; Chiemena Ohanale; Johannes F. Plate

doi:10.1055/s-0039-1683975

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2020; 33(08): 745-749
DOI: 10.1055/s-0039-1683975

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders

Chukwuweike U. Gwam

¹Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

,

Assem Sultan

²Department of Orthopaedic Surgery, Center for Spine Health, Cleveland Clinic, Cleveland, Ohio

,

Samuel Rosas

¹Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

,

Rashad Sullivan

¹Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

,

Michael Seem

¹Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

,

Chiemena Ohanale

³Department of Pharmacy, Howard University College of Pharmacy, Washington, District of Columbia

,

Johannes F. Plate

⁴Department of Orthopedics, Duke University School of Medicine, Durham, North Carolina

› Author Affiliations

Abstract

With a growing prevalence for chronic renal failure, arthroplasty surgeons will find it more likely to have dialysis dependent patients present for knee replacement. Previous retrospective studies using a matched cohort of patients have reported worse perioperative outcomes for dialysis-dependent patients. However, many of these studies failed to control for pertinent confounders. This study aims to fill in that void. The present study compares lengths of stay, discharge status, and 30-day outcomes between dialysis-dependent TKA recipients and a matched cohort of nondialysis dependent TKA recipients. The National Surgical Quality Improvement Program database was used to identify the study cohorts. Patients were propensity score matched based on patient-specific demographic variables, preoperative functional status, and preoperative laboratory values. Generalized regression models were conducted to assess the effects of dialysis dependency on perioperative outcomes. Dialysis dependent patients demonstrated longer mean lengths of stay (+1.14) and a lower likelihood for home discharge (odds ratio [OR] = 0.503). There was no increased risk of 30-day complications in dialysis dependent TKA patients. Our findings demonstrate no increased risk of 30-day complications after TKA when adjusting for pertinent confounders. This suggests TKA is safe for well optimized dialysis dependent patients prior to surgery.

Keywords

total knee arthroplasty - dialysis - perioperative outcomes - NSQIP - chronic kidney disease

Full Text

References

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