You Yongqing, Zhang Yijian, Qiang Lei, Sun Ye, Zhang Junxin, Bou Emily, Yan Moqi, Dai Kerong, Ding Muliang
Department of Nephrology, Affiliated Hospital of Nanjing Medical University, North District of Suzhou Municipal Hospital, Suzhou, China.
Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
J Orthop Surg Res. 2019 Mar 20;14(1):82. doi: 10.1186/s13018-019-1118-9.
Chronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients.
From 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications.
There were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers.
Compared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions.
已知慢性肾脏病（CKD）会增加骨科手术后的发病率和死亡率。本研究的目的是调查CKD如何影响髋关节手术患者的围手术期并发症。
2013年至2016年，共有230例行髋关节手术的患者（30例CKD患者和200例非CKD患者）纳入本研究。收集并分析了CKD患者和非CKD患者术前、术中和术后的数据。采用逻辑回归分析评估术后并发症的独立危险因素。
术前，CKD患者与非CKD患者在高血压患者数量（90.0%对27.3%，P＜0.001）、糖尿病患者数量（33.3%对8.7%，P = 0.01）、冠心病患者数量（20.0%对2.0%，P = 0.001）、吸烟习惯（56.7%对22.7%，P = 0.016）、贫血患者数量（90.0%对19.3%，P＜0.001）以及血红蛋白水平（94.1±19.7对121.3±18.8，P＜0.001）方面存在显著差异。CKD患者接受输血更为常见（50%对28.5%，P = 0.018）。术后，转至重症监护病房（ICU）的患者平均数量存在显著差异（73.3%对19.3%，P＜0.001）。此外，CKD患者与非CKD患者之间在血红蛋白量（92.5±16.8对107.5±18.3，P＜0.001）和白蛋白量（32.4±4.1对34.9±5.5，P = 0.02）方面也存在差异。逻辑回归分析表明，糖尿病、饮酒和贫血均为输血的独立危险因素，而年龄、CKD和骨质疏松均为转至ICU的独立危险因素。
与非CKD患者相比，CKD患者术前伴有更多心脏疾病。此外，CKD患者髋关节手术后更有可能接受输血并转至ICU。术前应充分纠正贫血以降低输血发生率。
