Chronic Kidney Disease and Outcomes of Total Hip Arthroplasty Patients Who Have Periprosthetic Hip Fractures.

Abstract

Patients who have end-stage renal disease (ESRD) and chronic kidney disease (CKD) have an increased risk of mortality and perioperative complications following primary total hip arthroplasty (THA). The association between increasing severity of renal disease with clinical and financial endpoints in patients treated for hip periprosthetic fracture (PPF) is underexplored in the literature. Hip PPF hospitalizations were identified using a large national database and grouped into non-CKD (NCKD), early-stage CKD (CKD 1 to 3), advanced-stage CKD (CKD 4 to 5), and ESRD. The primary outcome of the study was in-hospital mortality. The secondary outcomes included perioperative complications, hospitalization lengths of stay (LOS), costs, non-home discharges, and 30-day readmissions. Nonparametric tests were utilized to assess temporal trends. Of 108,836 patients treated for PPF, 17,115 (15.7%) had CKD. The overall prevalence of renal disease in patients who had PPF increased significantly from 2016 to 2020 (2020: 16.3% versus 2016: 14.6%, P < 0.001), while those who had ESRD decreased (2020: 1.3% versus 2016: 1.8%, P = 0.001). Multivariable logistic and linear regression models were utilized to evaluate the association of renal disease severity with outcomes of interest. Chronic kidney disease 1 to 3 (AOR 1.28, 95% CI 1.05 to 1.55), CKD 4 to 5 (AOR 2.00, 95% CI 1.45 to 2.75), and ESRD (AOR 4.20, 95% CI 2.93 to 6.03) were all associated with increased odds of in-hospital mortality. The increased severity of CKD was associated with a stepwise increase in LOS and cost. Advanced renal dysfunction was associated with worse postoperative outcomes and greater healthcare expenditures in patients undergoing management for PPF. Our findings warrant quality improvement efforts in arthroplasty PPF patients who had CKD 4 to 5 and ESRD.