Venishetty Nikit, Wukich Dane K, Beale Jack, Riley Martinez J, Toutoungy Michel, Mounasamy Varatharaj, Sambandam Senthil
Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA.
Knee Surg Relat Res. 2023 Aug 2;35(1):22. doi: 10.1186/s43019-023-00196-0.
Chronic kidney disease (CKD) is a growing disease that affects millions of people in the USA every year. Many CKD patients progress to end-stage renal disease (ESRD), necessitating the use of hemodialysis to alleviate symptoms and manage kidney function. Furthermore, many of these patients have lower bone quality and experience more postoperative complications. However, there is currently limited information on hospitalization information and perioperative complications in this population following procedures such as total knee arthroplasty (TKA). The purpose of this study was to assess the patient characteristics, demographics, and prevalence of postoperative problems among dialysis patients who received TKA.
In this retrospective study, we used the Nationwide Inpatient Sample (NIS) data from 2016 to 2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as dialysis patients, compared with those who were not. Propensity matching was conducted to consider associated factors that may influence perioperative complications.
From 2016 to 2019, 558,371 patients underwent TKAs, according to the National In-Sample (NIS) database. Of those, 418 patients (0.1%) were in the dialysis group, while the remaining 557,953 patients were included in the control group. The mean age of the dialysis group was 65.4 ± 9.8 years, and the mean age in the control group was 66.7 ± 9.5 years (p = 0.006). After propensity matching, dialysis group patients had a higher risk of receiving blood transfusions [odds ratio (OR): 2; 95% confidence interval (CI): 1.2, 3.4] and a significantly larger COC in comparison to those in the control group (91,434.3 USD versus 71,943.6 USD, p < 0.001). In addition, dialysis patients had significantly higher discharges to another facility, as compared with the control group patients.
The dialysis group had a significantly higher cost of care, higher rates of requiring blood transfusion, and more cases of being discharged to another facility than non-dialysis patients. This data will help providers make informed decisions about patient care and resource allocation for dialysis patients undergoing TKA.
慢性肾脏病（CKD）是一种日益常见的疾病，每年影响着美国数百万人口。许多CKD患者会进展为终末期肾病（ESRD），需要进行血液透析以缓解症状并维持肾功能。此外，这些患者中许多人的骨质质量较低，术后并发症更多。然而，目前关于接受全膝关节置换术（TKA）等手术的该人群住院信息和围手术期并发症的资料有限。本研究的目的是评估接受TKA的透析患者的患者特征、人口统计学信息以及术后问题的发生率。
在这项回顾性研究中，我们使用了2016年至2019年的全国住院患者样本（NIS）数据，分析接受TKA的患者中被归类为透析患者与未被归类为透析患者的围手术期并发症发生率、住院时间（LOS）和护理费用（COC）。进行倾向匹配以考虑可能影响围手术期并发症的相关因素。
根据国家样本（NIS）数据库，2016年至2019年期间，有558,371例患者接受了TKA。其中，418例患者（0.1%）在透析组，其余557,953例患者纳入对照组。透析组的平均年龄为65.4±9.8岁，对照组的平均年龄为66.7±9.5岁（p = 0.006）。倾向匹配后，与对照组相比，透析组患者接受输血的风险更高[比值比（OR）：2；95%置信区间（CI）：1.2，3.4]，护理费用显著更高（91,434.3美元对71,943.6美元，p < 0.001）。此外，与对照组患者相比，透析患者转至其他机构的出院率显著更高。
与非透析患者相比，透析组的护理费用显著更高，输血需求率更高，转至其他机构的出院病例更多。这些数据将有助于医疗服务提供者对接受TKA的透析患者的护理和资源分配做出明智决策。
