肾脏疾病对股骨颈骨折后人工股骨头置换术治疗效果的影响。

Effect of Kidney Disease on Hemiarthroplasty Outcomes After Femoral Neck Fractures.

机构信息

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.

出版信息

J Orthop Trauma. 2019 Nov;33(11):583-589. doi: 10.1097/BOT.0000000000001576.

DOI:10.1097/BOT.0000000000001576

PMID:31343596

Abstract

OBJECTIVE

To compare the outcomes of patients with predialysis chronic kidney disease (CKD) or end-stage renal disease (ESRD) with the outcomes of patients with no kidney disease after hemiarthroplasty (HA) for femoral neck fractures (FNF).

DESIGN

Retrospective review utilizing the Nationwide Readmissions Database.

SETTING

National database incorporating inpatient data from 22 states.

PATIENTS

Using the Nationwide Readmissions Database, 214,399 patients who underwent HA after FNF between 2010 and 2014 were identified and divided into 3 groups using ICD-9 diagnosis codes: no kidney disease (n = 176,300, 82%), predialysis CKD (n = 34,400, 16%), and ESRD (n = 3,698, 2%).

INTERVENTION

HA for FNF.

MAIN OUTCOME MEASUREMENT

Mortality, blood transfusion, and postoperative complications during index hospitalization. Hospital readmission, postoperative dislocation, periprosthetic fracture, and revision surgery within 90 days of surgery.

RESULTS

Compared to patients with no kidney disease, ESRD patients had an increased risk of mortality [odds ratio (OR) = 3.76, 95% confidence interval (CI), 2.95-4.78], blood transfusion (OR = 2.35, 95% CI, 2.08-2.64), and postoperative complications (OR = 1.64, 95% CI, 1.45-1.86) during the index hospitalization as well as an increased risk of 90-day hospital readmission (OR = 3.09, 95% CI, 2.72-3.50). Interestingly, even patients with predialysis CKD had an increased risk of mortality (OR = 1.80, 95% CI, 1.59-2.05), blood transfusion (OR = 1.66, 95% CI, 1.59-1.75), and postoperative complications (OR = 2.37, 95% CI, 2.25-2.50) during the index hospitalization as well as an increased risk of 90-day hospital readmission (OR = 1.43, 95% CI, 1.37-1.51).

CONCLUSIONS

This retrospective cohort study demonstrates that both ESRD and CKD patients have worse outcomes compared to patients with no kidney disease after HA for FNF.

LEVEL OF EVIDENCE

Prognostic Level III. See instructions for authors for a complete description of levels of evidence.

摘要

目的

比较股骨颈骨折（FNF）行人工髋关节置换术（HA）后，透析前慢性肾脏病（CKD）或终末期肾病（ESRD）患者与无肾病患者的结局。

设计

利用全国再入院数据库进行回顾性研究。

设置

全国数据库，纳入来自 22 个州的住院数据。

患者

利用全国再入院数据库，2010 年至 2014 年间，共识别出 214399 例 FNF 后行 HA 的患者，通过 ICD-9 诊断代码将其分为 3 组：无肾病（n=176300，82%）、透析前 CKD（n=34400，16%）和 ESRD（n=3698，2%）。

干预

FNF 行 HA。

主要观察指标

指数住院期间死亡率、输血及术后并发症。90 天内的术后再入院、术后脱位、假体周围骨折和翻修手术。

结果

与无肾病患者相比，ESRD 患者的死亡率[比值比（OR）=3.76，95%置信区间（CI）2.95-4.78]、输血（OR=2.35，95%CI 2.08-2.64）和术后并发症（OR=1.64，95%CI 1.45-1.86）风险增加，90 天内再入院风险也增加（OR=3.09，95%CI 2.72-3.50）。有趣的是，即使是透析前 CKD 患者的死亡率（OR=1.80，95%CI 1.59-2.05）、输血（OR=1.66，95%CI 1.59-1.75）和术后并发症（OR=2.37，95%CI 2.25-2.50）风险也增加，90 天内再入院风险也增加（OR=1.43，95%CI 1.37-1.51）。