Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI).We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome.We included 22 studies and 9384 patients (dialysis, n = 8921, KT, n = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%.Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors.In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates. Cite this article: EFORT Open Rev 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116.

Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis.

Background:End-stage renal disease is an independent risk factor for postoperative mortality and cardiovascular events, but dialysis vintage and its relationship with perioperative complication is ...

https://journals.sagepub.com/doi/pdf/10.1177/2309499019853887

Is dialysis vintage a perioperative risk for end-stage renal disease patients receiving total knee and hip arthroplasty.

Abstract Background Chronic kidney disease (CKD) is a growing disease that affects millions of people in the USA every year. Many CKD patients progress to end-stage renal disease (ESRD), necessitating the use of hemodialysis to alleviate symptoms and manage kidney function. Furthermore, many of these patients have lower bone quality and experience more postoperative complications. However, there is currently limited information on hospitalization information and perioperative complications in this population following procedures such as total knee arthroplasty (TKA). The purpose of this study was to assess the patient characteristics, demographics, and prevalence of postoperative problems among dialysis patients who received TKA. Methods In this retrospective study, we used the Nationwide Inpatient Sample (NIS) data from 2016 to 2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as dialysis patients, compared with those who were not. Propensity matching was conducted to consider associated factors that may influence perioperative complications. Results From 2016 to 2019, 558,371 patients underwent TKAs, according to the National In-Sample (NIS) database. Of those, 418 patients (0.1%) were in the dialysis group, while the remaining 557,953 patients were included in the control group. The mean age of the dialysis group was 65.4 ± 9.8 years, and the mean age in the control group was 66.7 ± 9.5 years ( p = 0.006). After propensity matching, dialysis group patients had a higher risk of receiving blood transfusions [odds ratio (OR): 2; 95% confidence interval (CI): 1.2, 3.4] and a significantly larger COC in comparison to those in the control group (91,434.3 USD versus 71,943.6 USD, p &lt; 0.001). In addition, dialysis patients had significantly higher discharges to another facility, as compared with the control group patients. Conclusions The dialysis group had a significantly higher cost of care, higher rates of requiring blood transfusion, and more cases of being discharged to another facility than non-dialysis patients. This data will help providers make informed decisions about patient care and resource allocation for dialysis patients undergoing TKA. 

Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications

Objectives: Prediction of ICU admission after surgery are important for rational decision-making for different patients in clinical practice. Little information is available about the risk factors of postoperative ICU admission in elderly patients undergoing orthopedic surgery. This study aimed to identify risk factors and develop a predictive model for postoperative ICU admission in elderly patients undergoing orthopedic surgery.
Methods: A total of 2826 cases of elderly patients receiving orthopedic surgery from October 2010 to September 2016 were retrospectively collected and analyzed. Logistic regression was used to evaluate the impacts of covariates. Support vector machine (SVM) was employed to develop a predictive model based on all pre-operative covariates and the demographic information.
Results: There were 256 patients transferred to ICU after surgery. ASA III or IV and emergency surgery were found to be independent risk factors while neuraxial anesthesia and joint surgery were protective factors. In addition, a SVM-based predictive model was developed, which had a sensitivity of 90.99%, a specificity of 99.10% and an area under ROC curve of 0.9678.
Conclusions: Our study revealed that emergency surgery, anesthesia method, surgery type and ASA grade were risk factors to predict postoperative ICU admission in elderly orthopedic patients.
doi: https://doi.org/10.12669/pjms.37.4.3371
How to cite this:Tang Y, Li H, Guo Z. Prediction of ICU admission after orthopedic surgery in elderly patients. Pak J Med Sci. 2021;37(4):1179-1184.  doi: https://doi.org/10.12669/pjms.37.4.3371
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

/pdf/prediction-of-icu-admission-after-orthopedic-surgery-in-3dm191hmtn.pdf

Prediction of ICU admission after orthopedic surgery in elderly patients.

Purpose To determine the effects of dialysis on postoperative and perioperative complications following rotator cuff repair (RCR) and knee arthroscopy (KA). Methods The National Surgical Quality Improvement Program (NSQIP) was queried from 2006 to 2018. Groups were matched for age, sex, body mass index, smoking status, preoperative functional status, and the American Society of Anesthesiologists (ASA) status. Chi-squared tests and Fisher’s exact tests were used to analyze the comorbidities. Differences in occurrences of postoperative adverse events (AE), mortality within 30 days, reoperations with 30 days, extended hospital stay (≥2 days), and readmissions within 30 days were analyzed using the Mantel-Haenszel test. Sign tests were used to evaluate differences in operative time, as well as length of hospital stay. Results Dialysis patients in both the RCR and KA groups had greater odds of experiencing any AE (OR: 6.33 and 7.46, P value: .031 and Conclusion This study identified significantly worse short-term complication rates in dialysis patients undergoing RCR and KA. Careful preoperative evaluation and postoperative surveillance are warranted in this high-risk patient group. Patients should be counseled appropriately on the increased complication risks associated with RCR and KA surgeries.

Increased Risk of Perioperative Complications in Dialysis Patients Following Rotator Cuff Repairs and Knee Arthroscopy

Background Total hip arthroplasty in patients with end-stage renal disease (ESRD) may be associated with a high complication rate. However, the perioperative complication and mortality rates in these patients after total knee arthroplasty (TKA) have rarely been investigated. The purposes of this study were to measure the mortality and complication rates and to evaluate the 2- to 10-year clinical outcome of TKA in dialysis patients at our hospital during the past decade. Methods We retrospectively assessed 21 patients (26 knees) with ESRD who underwent primary TKA between 2007 and 2015. A preoperative medical evaluation was performed in all patients to assess the risk of surgery. All patients had complete clinical and radiographic evaluations, and the outcome was scored using American Knee Society Scores and the Western Ontario and McMaster Universities Arthritis Index. Perioperative complications and mortality were recorded. Results One patient died of stroke 1 year after surgery (4.8% mortality). The mean follow-up period of other 20 patients was 5.8 years (69.7 months, 24 to 119 months). Six patients (28.5%) had medical complications, including pneumonia (n = 3), stroke (n = 2), and cardiovascular events (n = 3), after discharge from hospital. At the latest follow-up, 19 patients (90.5%) had improved clinical outcomes of the knee after TKA according to the American Knee Society Scores ( P P Conclusion Our study showed that TKA was a valid option for dialysis patients after careful preoperative evaluation. Most patients had an improved clinical outcome. There were no instances of prosthetic loosening or deep infection. However, dialysis patients under consideration for TKA need to be informed of the risk of possible medical complications due to the nature of ESRD.

Perioperative Complications of Total Knee Arthroplasty in Dialysis Patients.

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Perioperative Complications of Total Knee Arthroplasty in Dialysis Patients.