Revision ArthroplastyEstimated Glomerular Filtration Rate as a Risk Stratification Tool for Early Complications in Revision Total Hip and Knee Arthroplasty
Section snippets
Database
The present study was conducted using the American College of Surgeons National Quality Improvement Program database [[18], [19], [20]]. The database consists of more than 150 variables including preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes for major surgeries [19]. Trained and certified personnel perform the data entry with recertification occurring annually. In addition, regular inter-rater reliability audits and operating room
Results
The mean age of the 90-120 reference cohort was 60.6 years (standard deviation [SD] ± 11.6). The mean ages for the cohorts containing patients with eGFR >120, 60-90, 30-60, 15-30, and <15 were 56.9 (SD ± 13.1), 64.8 (SD ± 10.3), 71.3 (SD ± 9.8), 72.1 (SD ± 10.4), and 63.0 (SD ± 12.5), respectively. Table 1 displays the collected preoperative demographics and comorbidities. Table 2 contains the incidence of the complications and outcomes among the eGFR categories. Of note, mortality rates were
Discussion
Previous work supported correlation between CKD and mortality and complications in primary THA and TKA [[8], [9], [10], [11], [12], [13]]. Establishing an association between the spectrum of kidney function and mortality and complications which would allow for a patient center focus care; thus, the study aimed to evaluate the effect of staged eGFR as a measure of renal function on postoperative mortality and complications. Although eGFR necessitates a calculation, it is considered a more
Conclusion
Our study suggests an eGFR below 60 mL/min/1.73 m2 or at hyperfiltration levels is related to an increased risk major complication. When comparing eGFR, there appears to be a substantially increased risk of complications <30 mL/min/1.73 m2, as exemplified by an increased risk of major complications of 15% at an eGFR from 30 to 60 mL/min/1.73 m2, to an increase of 72% for <15 mL/min/1.73 m2 or on dialysis, respectively. A similar finding was discovered for mortality on spline regression.
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Department of Orthopaedic Surgery Cleveland Clinic 9500 Euclid Avenue/A41 Cleveland, OH 44195.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.12.007.
The authors declare no pertinent conflicts of interest. No financial support was used for the conductance of this study.