Chronic Kidney Disease and Outcomes of Total Hip Arthroplasty Patients Who Have Periprosthetic Hip Fractures.

BACKGROUND

Patients who have end-stage renal disease (ESRD) and chronic kidney disease (CKD) have an increased risk of mortality and perioperative complications after primary total hip arthroplasty. The association between increasing severity of renal disease with clinical and financial end points in patients treated for hip periprosthetic fracture (PPF) is underexplored in the literature.

METHODS

Hip PPF hospitalizations were identified using a large national database and grouped into non-CKD, early-stage CKD (CKD 1 to 3), advanced-stage CKD (CKD 4 to 5), and ESRD. The primary outcome of the study was in-hospital mortality. The secondary outcomes included perioperative complications, hospitalization length of stay, costs, non-home discharges, and 30-day readmissions. Nonparametric tests were used to assess temporal trends. Of 108,836 patients treated for PPF, 17,115 (15.7%) had CKD. The overall prevalence of renal disease in patients who had PPF increased significance from 2016 to 2020 (2020: 16.3% versus 2016: 14.6%, P < 0.001), whereas those who had ESRD decreased (2020: 1.3% versus 2016: 1.8%, P = 0.001). Multivariable logistic and linear regression models were used to evaluate the association of renal disease severity with outcomes of interest.

RESULTS

Chronic kidney disease 1 to 3 (adjusted odds ratio [AOR] 1.28, 95% CI 1.05 to 1.55), CKD 4 to 5 (AOR 2.00, 95% CI 1.45 to 2.75), and ESRD (AOR 4.20, 95% CI 2.93 to 6.03) were all associated with increased odds of in-hospital mortality. The increased severity of CKD was associated with a stepwise increase in length of stay and cost.

CONCLUSIONS

Advanced renal dysfunction was associated with worse postoperative outcomes and greater health care expenditures in patients undergoing management for PPF. Our findings warrant quality improvement efforts in arthroplasty PPF patients who had CKD 4 to 5 and ESRD.