Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty.
BACKGROUND
Dialysis-dependent patients can develop osteoarthritis or osteonecrosis, warranting hip or knee arthroplasty. Their comorbidities predispose them to complications. Our goal was to determine inpatient outcomes of dialysis-dependent patients after primary elective total hip or knee arthroplasty.


METHODS
In the National Inpatient Sample, we identified 2934 dialysis-dependent patients who had undergone total hip or knee arthroplasty from 2000 through 2009 and compared them with 6,186,475 patients who had undergone the same procedures and were not dialysis-dependent. We described demographic characteristics, comorbidities, and outcomes and assessed associations of dialysis status with inpatient mortality and complications.


RESULTS
In the hip arthroplasty group, dialysis-dependent patients were younger (63.2 compared with 65.2 years; p = 0.0476) and more commonly diagnosed with osteonecrosis (34.29% compared with 10.94%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (1.88% compared with 0.13%; p < 0.0001) and greater overall complication rates (9.98% compared with 4.97%; p = 0.0001). Dialysis was an independent risk factor for mortality (odds ratio, 6.66; 95% confidence interval [95% CI], 2.66 to 16.66) and complications (odds ratio, 1.53; 95% CI, 1.01 to 2.33). In the knee arthroplasty group, dialysis-dependent patients were similar in age (66.7 compared with 66.8 years; p = 0.8085) and were more commonly diagnosed with osteonecrosis (3.32% compared with 0.74%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (0.92% compared with 0.10%; p < 0.0001) and greater overall complication rates (12.48% compared with 5.00%; p < 0.0001). Dialysis status was an independent risk factor for mortality (odds ratio, 3.31; 95% CI, 1.04 to 10.54) and complications (odds ratio, 1.86; 95% CI, 1.34 to 2.60).


CONCLUSIONS
Total hip and knee arthroplasty in dialysis-dependent patients presents high risk, with inpatient mortality rates ten to twenty times greater and overall complication rates two times greater than in non-dialysis-dependent patients. Arthroplasty should be approached with caution and preferably should be delayed until after renal transplantation.
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Karthikeyan E
KE
Ponnusamy
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Amit
A
Jain
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Savyasachi C
SC
Thakkar
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Robert S
RS
Sterling
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Richard L
RL
Skolasky
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail address for H.S. Khanuja: editorialservices@jhmi.edu.
Harpal S
HS
Khanuja
D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome