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Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients

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Abstract

Purpose

The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients.

Methods

The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016–2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016–2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications.

Results

Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3 days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility.

Conclusions

This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk–benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.

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Authors and Affiliations

  1. Trauma and Orthopaedics, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK

    Vishesh Khanna

  2. School of Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Vishaal Sakthivelnathan

  3. Carroll High School, Southlake, TX, USA

    Tejas Senthil

  4. Burrell College of Osteopathic Medicine, Las Cruces, NM, USA

    Sushrruti Varatharaj

  5. Department of Orthopedics, University of Texas Southwestern, Dallas, USA

    Varatharaj Mounasamy & Senthil Sambandam

  6. Orthopedics, Dallas VAMC, Dallas, TX, USA

    Varatharaj Mounasamy & Senthil Sambandam

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  1. Vishesh Khanna
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  2. Vishaal Sakthivelnathan
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Khanna, V., Sakthivelnathan, V., Senthil, T. et al. Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients. JOIO 57, 336–343 (2023). https://doi.org/10.1007/s43465-022-00799-x

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  • DOI: https://doi.org/10.1007/s43465-022-00799-x

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