School of Medicine and Health Sciences Poster Presentations

Title

Impact of Chronic Kidney Disease on Postoperative Complications following Revision Total Knee Arthroplasty

Poster Number

184

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

Arthroplasty, Chronic Kidney Disease, Post-operative Complication, TKA, Knee

Publication Date

Spring 2018

Abstract

Background: Total knee arthroplasty (TKA) is a common orthopedic procedure that is becoming increasingly common in the United States. With an aging population the per capita number of TKAs have doubled from 1991 to 2010 and this rate is projected to grow exponentially over the next decade.

Chronic kidney disease (CKD), characterized by a gradual loss of kidney function, is a growing national trend in the United States and is associated with medical comorbidities and increased incidence of postoperative morbidity and mortality. CKD is particularly common amongst an aging population, many of whom are likely to receive a TKA at some point in their lifetime. This study examines the impact of pre-operative kidney function on the risk of post-operative complications for revision total knee arthroplasty.

Methods: A retrospective cohort study was performed from data collected via the American College of Surgeons National Quality Improvement Program Database from 2005 to 2014. Patients who had underwent revision TKA were identified by CPT code and further stratified based on pre-operative GFR. Univariate and multivariate analyses were conducted appropriately.

Results: In total, 8,454 patients were identified for this study. Decreased GFR was shown to have a significant increase in overall complications, pneumonia, renal insufficiency, renal failure, urinary tract infection, sepsis, septic shock, death, extended hospital length of stay and unplanned return to OR. Multivariate analysis revealed GFR to be an independent risk factor for extended length of stay, renal insufficiency and renal failure.

Conclusion: This evidence suggests a trend of higher post-operative complication rates among patients with CKD receiving revision TKA, with particular risk stratified based on worsening CKD stage. In particular, patients with less than 30 GFR had an almost 30% chance of incidence for development of a postoperative complication. Surgeons should carefully consider CKD stage and GFR status when determining patients who would appropriately benefit from revision TKA.

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Impact of Chronic Kidney Disease on Postoperative Complications following Revision Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a common orthopedic procedure that is becoming increasingly common in the United States. With an aging population the per capita number of TKAs have doubled from 1991 to 2010 and this rate is projected to grow exponentially over the next decade.

Chronic kidney disease (CKD), characterized by a gradual loss of kidney function, is a growing national trend in the United States and is associated with medical comorbidities and increased incidence of postoperative morbidity and mortality. CKD is particularly common amongst an aging population, many of whom are likely to receive a TKA at some point in their lifetime. This study examines the impact of pre-operative kidney function on the risk of post-operative complications for revision total knee arthroplasty.

Methods: A retrospective cohort study was performed from data collected via the American College of Surgeons National Quality Improvement Program Database from 2005 to 2014. Patients who had underwent revision TKA were identified by CPT code and further stratified based on pre-operative GFR. Univariate and multivariate analyses were conducted appropriately.

Results: In total, 8,454 patients were identified for this study. Decreased GFR was shown to have a significant increase in overall complications, pneumonia, renal insufficiency, renal failure, urinary tract infection, sepsis, septic shock, death, extended hospital length of stay and unplanned return to OR. Multivariate analysis revealed GFR to be an independent risk factor for extended length of stay, renal insufficiency and renal failure.

Conclusion: This evidence suggests a trend of higher post-operative complication rates among patients with CKD receiving revision TKA, with particular risk stratified based on worsening CKD stage. In particular, patients with less than 30 GFR had an almost 30% chance of incidence for development of a postoperative complication. Surgeons should carefully consider CKD stage and GFR status when determining patients who would appropriately benefit from revision TKA.