Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5, Hutong, Haiyuncang, Dongcheng District, Beijing City, 100700, China.
Hunan University of Chinese Medicine, Changsha City, Hunan Province, China.
Int Orthop. 2020 Feb;44(2):215-229. doi: 10.1007/s00264-019-04437-4. Epub 2019 Dec 13.
Comorbidities in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) may compromise outcomes with increased hospital stays, re-admission, and mortality rates. We aimed to determine whether chronic kidney disease (CKD) affects post-operative outcomes of patients undergoing total joint arthroplasty (TJA).
To identify studies for this review and meta-analysis, two independent reviewers searched PubMed, Cochrane, EMBASE, and Google Scholar until April 1, 2019, and identified additional studies by manual search of reference lists. Prospective or retrospective studies with quantitative outcomes for patients undergoing TJA were selected. Outcomes were compared between patients with underlying CKD stage ≥ 3 or eGFR < 60 mL/min/1.73 m2 versus mild/non-CKD as controls. Main endpoints were mortality, re-operation, and re-admission rates.
Among 59 studies reviewed, 19 meeting the eligibility criteria were included, providing data of 2,141,393 patients. After THA or TKA, CKD was associated with higher mortality risk than non-CKD (pooled OR 2.20, 95%CI = 1.90 to 2.54; P < 0.001); no significant differences were seen in re-operation between CKD and non-CKD patients (pooled OR 1.26, 95%CI = 0.84 to 1.88; P = 0.266); and CKD patients had higher any-cause re-admission rates (pooled OR = 1.57, 95%CI = 1.27 to 1.94, P < 0.001).
Underlying CKD predicts adverse outcomes after elective TJA with increased risk of mortality, re-admission, surgical site infection, and perioperative transfusion. Findings of this review and meta-analysis highlight CKD as a critical contributor to complications after TJA and may be helpful to surgeons when advising patients about associated risks of TJA.
接受全髋关节置换术（THA）和全膝关节置换术（TKA）的患者合并症可能会导致住院时间延长、再入院和死亡率增加，从而影响治疗效果。我们旨在确定慢性肾脏病（CKD）是否会影响接受全关节置换术（TJA）的患者的术后结果。
为了进行这项综述和荟萃分析，两位独立的审查员搜索了 PubMed、Cochrane、EMBASE 和 Google Scholar，检索时间截至 2019 年 4 月 1 日，并通过手动搜索参考文献确定了其他研究。选择了具有 TJA 患者定量结果的前瞻性或回顾性研究。将患有基础 CKD 3 期或 eGFR<60mL/min/1.73m2的患者与轻度/非 CKD 作为对照组的结果进行比较。主要终点是死亡率、再手术率和再入院率。
在审查的 59 项研究中，有 19 项符合入选标准，共提供了 2141393 例患者的数据。THA 或 TKA 后，与非 CKD 患者相比，CKD 患者的死亡率更高（合并 OR 2.20，95%CI = 1.90 至 2.54；P<0.001）；CKD 患者与非 CKD 患者之间的再手术率无显著差异（合并 OR 1.26，95%CI = 0.84 至 1.88；P=0.266）；CKD 患者的任何原因再入院率更高（合并 OR=1.57，95%CI = 1.27 至 1.94，P<0.001）。
基础 CKD 预测了择期 TJA 后的不良结果，增加了死亡率、再入院率、手术部位感染和围手术期输血的风险。这项综述和荟萃分析的结果强调了 CKD 是 TJA 后并发症的一个关键因素，可能有助于外科医生在向患者提供 TJA 相关风险时提供参考。
