Varun Puvanesarajah1, Raj Amin1, Rabia Qureshi2, Babar Shafiq1, Ben Stein3, Hamid Hassanzadeh2, Seth Yarboro4. 1. Department of Orthopedic Surgery, Johns Hopkins Medical Center, Baltimore, MD, USA. 2. Department of Orthopedic Surgery, University of Virginia, Box 800159 HSC, Charlottesville, VA, 22908, USA. 3. Department of Orthopedic Surgery, George Washington Medical Center, Washington, DC, USA. 4. Department of Orthopedic Surgery, University of Virginia, Box 800159 HSC, Charlottesville, VA, 22908, USA. SRY2J@hscmail.mcc.virginia.edu.
Abstract
INTRODUCTION: Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly. METHODS: The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes. RESULTS: A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications. CONCLUSION: Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.
INTRODUCTION: Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly. METHODS: The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes. RESULTS: A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications. CONCLUSION: Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.
Authors: M Orth; D Osche; P Mörsdorf; J H Holstein; M F Rollmann; T Fritz; T Pohlemann; A Pizanis Journal: Arch Orthop Trauma Surg Date: 2022-09-02 Impact factor: 2.928
Authors: Diane R Wagner; Sonali Karnik; Zachary J Gunderson; Jeffery J Nielsen; Alanna Fennimore; Hunter J Promer; Jonathan W Lowery; M Terry Loghmani; Philip S Low; Todd O McKinley; Melissa A Kacena; Matthias Clauss; Jiliang Li Journal: World J Stem Cells Date: 2019-06-26 Impact factor: 5.326