TY - JOUR
T1 - Postoperative Outcomes Among Dialysis Patients Undergoing Hip Fracture Repair
AU - Conover Benjamin, M.
AU - Wukich Dane, K.
AU - Senthil, Sambandam
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by The University of Texas Southwestern Department of Orthopaedic Surgery which provided funding for access to the Bellweather PearlDiver database.
Publisher Copyright:
© The Author(s) 2023.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Geriatric hip fractures are strongly correlated with increased morbidity. Even so, postoperative outcomes following surgical repair of hip fractures for patients with end stage renal disease lack extensive investigation. Chronic kidney disease (CKD) poses unique risks for surgical procedures as it has been associated with several complications. Little information is available regarding the outcomes of patients whose renal function decline necessitates dialysis usage. The purpose of this study was to compare post-surgical outcomes based on dialysis usage among CKD patients requiring hip fracture repair. Materials and Methods: We used the PearlDiver database to identify hip fracture repair patients diagnosed with stages 3, 4, and 5 CKD. We matched the populations according to patient characteristics and comorbidities. We then compared patient complication rates among dialyzed and non-dialyzed CKD patients following hip fracture repair at 30 days, 90 days, and 1 year following the procedure. Results: Dialyzed patients were more likely to experience myocardial infarction within 30 days (P =.02) and 90 days (P =.002). Dialyzed patients suffered cardiac arrest at higher rates within the same time intervals (P =.02; P =.002). Furthermore, dialysis patients developed sepsis (P =.005) and pneumonia (P =.005) at higher rates within 30 days of operation. Dialysis patients did not have increased risk of blood transfusion within 30 days of the operation (P =.07). Discussion: We found significant increases in myocardial infarction, cardiac arrest, pneumonia, and sepsis risk among dialyzed CKD patients. Blood transfusion risk failed to reach statistical significance. Our findings are consistent with previous research regarding CKD pathophysiology and associated perioperative outcomes. Conclusion: Given the drastic decline of renal function among patients on dialysis, our findings may be attributable to decreased glomerular filtration rate in CKD as well as dialysis itself. Regardless, multidisciplinary collaboration should be employed when performing hip fracture repair on a patient who is actively undergoing hemodialysis.
AB - Background: Geriatric hip fractures are strongly correlated with increased morbidity. Even so, postoperative outcomes following surgical repair of hip fractures for patients with end stage renal disease lack extensive investigation. Chronic kidney disease (CKD) poses unique risks for surgical procedures as it has been associated with several complications. Little information is available regarding the outcomes of patients whose renal function decline necessitates dialysis usage. The purpose of this study was to compare post-surgical outcomes based on dialysis usage among CKD patients requiring hip fracture repair. Materials and Methods: We used the PearlDiver database to identify hip fracture repair patients diagnosed with stages 3, 4, and 5 CKD. We matched the populations according to patient characteristics and comorbidities. We then compared patient complication rates among dialyzed and non-dialyzed CKD patients following hip fracture repair at 30 days, 90 days, and 1 year following the procedure. Results: Dialyzed patients were more likely to experience myocardial infarction within 30 days (P =.02) and 90 days (P =.002). Dialyzed patients suffered cardiac arrest at higher rates within the same time intervals (P =.02; P =.002). Furthermore, dialysis patients developed sepsis (P =.005) and pneumonia (P =.005) at higher rates within 30 days of operation. Dialysis patients did not have increased risk of blood transfusion within 30 days of the operation (P =.07). Discussion: We found significant increases in myocardial infarction, cardiac arrest, pneumonia, and sepsis risk among dialyzed CKD patients. Blood transfusion risk failed to reach statistical significance. Our findings are consistent with previous research regarding CKD pathophysiology and associated perioperative outcomes. Conclusion: Given the drastic decline of renal function among patients on dialysis, our findings may be attributable to decreased glomerular filtration rate in CKD as well as dialysis itself. Regardless, multidisciplinary collaboration should be employed when performing hip fracture repair on a patient who is actively undergoing hemodialysis.
KW - chronic kidney disease
KW - dialysis
KW - end-stage renal disease
KW - geriatric
KW - hip fracture
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U2 - 10.1177/21514593231195992
DO - 10.1177/21514593231195992
M3 - Article
C2 - 37600450
AN - SCOPUS:85168350838
SN - 2151-4585
VL - 14
JO - Geriatric Orthopaedic Surgery and Rehabilitation
JF - Geriatric Orthopaedic Surgery and Rehabilitation
ER -