Increased Risks of Surgical Site Infection and In-Hospital Mortality Following Knee Arthroplasty in Dialysis Patients: Insights From a Japanese Nationwide Cohort.

Abstract

Dialysis patients often develop advanced knee osteoarthritis, necessitating knee arthroplasty. Although total knee arthroplasty is commonly performed, limited data exist on perioperative complications among Japanese dialysis patients. This study uses a Japanese nationwide medical claims database to investigate the incidence of perioperative complications and mortality in dialysis versus nondialysis patients undergoing knee arthroplasty. A retrospective analysis was conducted using data from a Japanese nationwide database (April 2016 to March 2023). Propensity score matching was used to balance confounding variables, including age, sex, body mass index, surgical procedures, and comorbidities. A 1:1 propensity score-matched cohort of 1,923 dialysis and 1,923 nondialysis patients was analyzed. Outcomes included in-hospital mortality, surgical site infections, and other complications. Multivariate logistic regression identified risk factors. Dialysis patients exhibited significantly higher in-hospital mortality and surgical site infection risks. The odds ratio (OR) for surgical site infection in dialysis patients was 2.17 (95% confidence interval: 1.31 to 3.61). The dialysis group demonstrated a significantly higher in-hospital mortality risk compared to the nondialysis group (P < 0.0001). No in-hospital deaths were observed among nondialysis patients postmatching, precluding the calculation of an OR. Bilateral simultaneous surgery emerged as an additional independent risk factor, with an OR of 9.94 (95% confidence interval: 1.95 to 50.74) in dialysis patients. This propensity score-matched study highlights significantly elevated surgical site infection and in-hospital mortality risks for dialysis patients undergoing knee arthroplasty. These findings underscore the necessity for careful perioperative management and the avoidance of high-risk procedures, such as bilateral simultaneous surgeries, in dialysis patients.