OTA international : the open access journal of orthopaedic trauma · 2025
Outcomes after surgical fixation of lower extremity fractures in patients with chronic kidney disease.
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Jeffs Alexander D, Toy Kristin A, White Beau R, Lin Feng-Chang, Hu Di, Fisher Margaret D, McCartney Jason, Siegel Judith A, Chen Andrew T
Аннотация
OBJECTIVES: Assess mortality and complications in patients with chronic kidney disease (CKD) after fixation of lower extremity fractures.
DESIGN: Retrospective cohort.
SETTING: Single academic level 1 trauma center.
PATIENTS: Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle).
INTERVENTION: Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD.
OUTCOME MEASUREMENTS: Mortality and complication rates at time points up to 2 years or until death.
RESULTS: Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD.
CONCLUSIONS: Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group.
LEVEL OF EVIDENCE: Therapeutic level III.
DESIGN: Retrospective cohort.
SETTING: Single academic level 1 trauma center.
PATIENTS: Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle).
INTERVENTION: Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD.
OUTCOME MEASUREMENTS: Mortality and complication rates at time points up to 2 years or until death.
RESULTS: Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD.
CONCLUSIONS: Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group.
LEVEL OF EVIDENCE: Therapeutic level III.