title: Complications and Mortality in Chronic Renal Failure Patients Undergoing Total Joint Arthroplasty: A Comparison Between Dialysis and Renal Transplant Patients.
abstract: BACKGROUND
  In total joint arthroplasty (TJA) literature, there is a paucity of large cohort studies comparing chronic kidney disease (CKD) and end-stage renal disease (ESRD) vs non-CKD/ESRD patients. Thus, the purposes of this study were (1) to identify inhospital complications and mortality in CKD/ESRD and non-CKD/ESRD patients and (2) compare inhospital complications and mortality between dialysis and renal transplantation patients undergoing TJA.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample database for patients with and without diagnosis of CKD/ESRD and those with a renal transplant or on dialysis undergoing primary or revision total knee or hip arthroplasty from 2007 to 2011. Patient comorbidities were identified using the Elixhauser comorbidity index. International Classification of Diseases, Ninth Revision, codes were used to identify postoperative surgical site infections (SSIs), wound complications, deep vein thrombosis, and transfusions.
  
  
  RESULTS
  Chronic kidney disease/ESRD was associated with greater risk of SSIs (odds ratio [OR], 1.4; P<.001), wound complications (OR, 1.1; P=.01), transfusions (OR, 1.6; P<.001), deep vein thrombosis (OR, 1.4; P=.03), and mortality (OR, 2.1; P<.001) than non-CKD/ESRD patients. Dialysis patients had higher rates of SSI, wound complications, transfusions, and mortality compared to renal transplant patients.
  
  
  CONCLUSIONS
  Chronic kidney disease/ESRD patients had a greater risk of SSIs and wound complications compared to those without renal disease, and the risk of these complications was even greater in CKD/ESRD patients receiving dialysis. These findings emphasize the importance of counseling CKD patients about higher potential complications after TJA, and dialysis patients may be encouraged to undergo renal transplantation before TJA.
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Priscilla K
authors.initials: PK
authors.lastname: Cavanaugh
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Post
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Fabio R
authors.initials: FR
authors.lastname: Orozco
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Ong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D006435:Renal Dialysis; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
keywords: chronic renal failure; complications; hemodialysis; renal transplant; total hip arthroplasty; total knee arthroplasty