Introduction:

Total hip arthroplasty (THA) in end-stage renal disease (ESRD) patients is associated with increased complications. Controversy exists whether elective THA should be performed while these patients are on haemodialysis (HD) or following renal transplant (RT). This study seeks to compare THA outcomes in HD versus RT patients.

Methods:

A national database was retrospectively reviewed using ICD codes to identify all HD and RT patients who underwent primary THA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared between cohorts using Wald and chi-square tests. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), non-home discharge, cost, readmission, and medical/surgical complications. Multivariate regression was used to determine independent associations. Significance was determined with a 2-tailed p-value of 0.05.

Results:

11,133 patients underwent THA, 61.6% HD and 39.4% RT patients. RT patients were younger, had fewer comorbidities, and more likely to have private insurance. After adjusting for these differences, RT patients had a lower rate of mortality (OR 0.31, p = 0.01), complications (OR 0.54, p < 0.01), cardiopulmonary complications (OR 0.54, p = 0.04), sepsis (OR 0.43, p < 0.01), and blood transfusion (OR 0.39, p < 0.001) during the index hospitalisation. RT was associated with decreased LOS (−2.0 days, p < 0.001), non-home discharge (OR 0.35, p < 0.001), and hospital cost (−$6,000, p < 0.001). RT had a lower rate of readmission (OR 0.60, p < 0.001) and revision surgery (OR 0.24, p = 0.01) within 90 days.

Conclusions:

These findings suggest HD patients are a high-risk population in THA compared to RT patients and warrant stringent perioperative monitoring.

中文翻译：

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血液透析与肾移植患者全髋关节置换术结局的比较

介绍：

终末期肾病（ESRD）患者的全髋关节置换术（THA）与并发症增加有关。在这些患者进行血液透析 (HD) 或肾移植 (RT) 后是否应进行选择性 THA 存在争议。本研究旨在比较 HD 与 RT 患者的 THA 结果。

方法：

使用 ICD 代码对国家数据库进行回顾性审查，以确定 2010 年至 2018 年接受原发性 THA 的所有 HD 和 RT 患者。使用 Wald 和卡方检验比较队列之间的人口统计学、合并症和医院因素。主要结局是住院死亡率，而次要结局包括住院时间 (LOS)、非居家出院、费用、再入院和内科/手术并发症。多元回归用于确定独立关联。显着性用 0.05 的 2 尾p值确定。

结果：

11,133 名患者接受了 THA，61.6% 的 HD 和 39.4% 的 RT 患者。RT 患者更年轻，合并症更少，更有可能拥有私人保险。在调整这些差异后，RT 患者的死亡率（OR 0.31，p  = 0.01）、并发症（OR 0.54，p  < 0.01）、心肺并发症（OR 0.54，p  = 0.04）、败血症（OR 0.43，p < 0.01）和 住院期间 输血（OR 0.39，p < 0.001）。RT 与 LOS 降低（-2.0 天，p  < 0.001）、非居家出院（OR 0.35，p  < 0.001）和住院费用（-6,000 美元，p  < 0.001）相关。RT 的再入院率较低（OR 0.60，p < 0.001) 和 90 天内的 翻修手术 (OR 0.24, p = 0.01)。

结论：

这些发现表明，与 RT 患者相比，HD 患者是 THA 的高危人群，需要进行严格的围手术期监测。