Chronic kidney disease impact on total joint arthroplasty outcomes: A National Inpatient Sample-based study

Abstract

Introduction: In the United States, chronic kidney disease (CKD) affects roughly 11% of the population or 19.2 million people. As the prevalence of CKD and demand for total joint arthroplasty (TJA) continue to rise, it is critical to assess the impact of CKD on postoperative clinical and economic outcomes.

Methods: Discharge data from 2006 to 2011 National Inpatient Sample were used for this study. A total of 851,150 TJA patients were divided into three cohorts: group 1 included no CKD, CKD stage I, and CKD stage II; group 2 included CKD stage III and stage IV; group 3 included CKD stage V. Inverse probability of treatment weighting/propensity score weighting was used to predict outcome variables as a function of age, sex, and Elixhauser comorbidities. Patients were compared against group I for in-hospital postoperative outcomes.

Results: Stage III/IV CKD patients undergoing primary TJA had higher odds of any complication (odds ratio (OR), 2.63; p < 0.0001), longer length of stay (LOS), and higher total charge (LOS, 4.34 vs. 3.48 days; total charge, US$56,003 vs. US$46,115; p < 0.0001) when compared to patients with no CKD/stage I or II. Similarly, stage V CKD patients undergoing primary TJA had higher odds of any complication (OR, 1.64; p < 0.0001), longer LOS, and higher total charges (LOS, 5.81 vs. 3.48 days; total charge, US$59,869 vs. US$46,115) than their counterparts with no CKD/stage I or II CKD.

Discussion: Our results indicate that stage III, IV, or V CKD, compared with those with no CKD, stage I or II patients are at a greater risk for postoperative complications and consume more resources following TJA.

Keywords: chronic kidney disease; complications; inpatient outcomes; total joint replacement.