Lin Meng-Hao, Lin Su-Ju, Kuo Liang-Tseng, Chen Tien-Hsing, Chen Chi-Lung, Yu Pei-An, Tsai Yao-Hung, Hsu Wei-Hsiu
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
Diagnostics (Basel). 2021 May 1;11(5):822. doi: 10.3390/diagnostics11050822.
The number of diabetic patients with chronic kidney disease (CKD) undergoing shoulder arthroplasty is growing. This study aims to compare perioperative outcomes of shoulder arthroplasty in diabetic patients at different renal function stages. Between 1998 and 2013, a total of 4443 diabetic patients with shoulder arthroplasty were enrolled: 1174 (26%) had CKD without dialysis (CKD group), 427 (9%) underwent dialysis (dialysis group), and 3042 (68%) had no CKD (non-CKD group). Compared with the non-CKD group, the CKD (odds ratio [OR], 4.69; 95% confidence interval [CI], 2.02-10.89) and dialysis (OR, 6.71; 95% CI, 1.63-27.73) groups had a high risk of in-hospital death. The dialysis group had a high risk of infection after shoulder arthroplasty compared with the CKD (subdistribution hazard ratio [SHR], 1.69; 95% CI, 1.07-2.69) and non-CKD (SHR, 1.76; 95% CI, 1.14-2.73) groups. The dialysis group showed higher risks of all-cause readmission and mortality than the CKD and non-CKD groups after a 3-month follow-up. In conclusion, CKD was associated with worse outcomes after shoulder arthroplasty. Compared with those without CKD, CKD patients had significantly increased readmission and mortality risks but did not have an increased risk of surgical complications, including superficial infection or implant removal.
接受肩关节置换术的糖尿病合并慢性肾脏病（CKD）患者数量正在增加。本研究旨在比较不同肾功能阶段的糖尿病患者行肩关节置换术的围手术期结局。1998年至2013年，共纳入4443例行肩关节置换术的糖尿病患者：1174例（26%）患有未透析的CKD（CKD组），427例（9%）接受透析（透析组），3042例（68%）无CKD（非CKD组）。与非CKD组相比，CKD组（优势比[OR]，4.69；95%置信区间[CI]，2.02 - 10.89）和透析组（OR，6.71；95%CI，1.63 - 27.73）院内死亡风险较高。与CKD组（亚分布风险比[SHR]，1.69；95%CI，1.07 - 2.69）和非CKD组（SHR，1.76；95%CI，1.14 - 2.73）相比，透析组肩关节置换术后感染风险较高。3个月随访后，透析组全因再入院和死亡风险高于CKD组和非CKD组。总之，CKD与肩关节置换术后较差的结局相关。与无CKD的患者相比，CKD患者再入院和死亡风险显著增加，但手术并发症风险未增加，包括浅表感染或植入物取出。
