Casey Jo Humbyrd1, Sunjae Bae2,3, Lauren M Kucirka2, Dorry L Segev2,3. 1. 1 Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA. 2. 2 Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA. 3. 3 Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, MD, USA.
Abstract
BACKGROUND: Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR). METHODS: We studied Medicare patients with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted for a transplant, not waitlisted, or received a transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, and year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR risk factors, and determine treatment patterns and outcomes. RESULTS: We identified 1091 ATRs (incidence, 3.80/10 000 person-years; 95% confidence interval [CI], 3.58-4.03). Compared with transplant recipients, nonwaitlisted patients had a lower incidence (aIRR, 0.44; 95% CI, 0.37-0.53), and waitlisted patients had a similar incidence (aIRR, 0.94; 95% CI, 0.78-1.12) of ATR. ATR incidence was higher among patients taking fluoroquinolones (aIRR, 1.65; 95% CI, 1.32-1.84) and corticosteroids (aIRR, 1.72; 95% CI, 1.44-2.05) compared with those who did not. Patients with ATR were younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Seventeen percent of patients received operative treatment within 14 days of ATR diagnosis. The 30-day cumulative incidence of operative site infections was 6.5%. CONCLUSION: The incidence of ATR was higher among transplant recipients and waitlisted patients compared with nonwaitlisted patients. Younger age, higher body mass index, fewer comorbidities, fluoroquinolone use, and corticosteroid use were risk factors for ATR. Patients were more likely to receive nonoperative than operative treatment for ATR. Those who underwent operative treatment had a low incidence of operative site infection. LEVEL OF EVIDENCE: Prognostic level III, comparative study.
BACKGROUND: Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR). METHODS: We studied Medicare patients with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted for a transplant, not waitlisted, or received a transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, and year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR risk factors, and determine treatment patterns and outcomes. RESULTS: We identified 1091 ATRs (incidence, 3.80/10 000 person-years; 95% confidence interval [CI], 3.58-4.03). Compared with transplant recipients, nonwaitlisted patients had a lower incidence (aIRR, 0.44; 95% CI, 0.37-0.53), and waitlisted patients had a similar incidence (aIRR, 0.94; 95% CI, 0.78-1.12) of ATR. ATR incidence was higher among patients taking fluoroquinolones (aIRR, 1.65; 95% CI, 1.32-1.84) and corticosteroids (aIRR, 1.72; 95% CI, 1.44-2.05) compared with those who did not. Patients with ATR were younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Seventeen percent of patients received operative treatment within 14 days of ATR diagnosis. The 30-day cumulative incidence of operative site infections was 6.5%. CONCLUSION: The incidence of ATR was higher among transplant recipients and waitlisted patients compared with nonwaitlisted patients. Younger age, higher body mass index, fewer comorbidities, fluoroquinolone use, and corticosteroid use were risk factors for ATR. Patients were more likely to receive nonoperative than operative treatment for ATR. Those who underwent operative treatment had a low incidence of operative site infection. LEVEL OF EVIDENCE: Prognostic level III, comparative study.
Authors: A Hart; J M Smith; M A Skeans; S K Gustafson; D E Stewart; W S Cherikh; J L Wainright; A Kucheryavaya; M Woodbury; J J Snyder; B L Kasiske; A K Israni Journal: Am J Transplant Date: 2017-01 Impact factor: 8.086
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Patrick Albertus; John Ayanian; Rajesh Balkrishnan; Jennifer Bragg-Gresham; Jie Cao; Joline L T Chen; Elizabeth Cope; Sai Dharmarajan; Xue Dietrich; Ashley Eckard; Paul W Eggers; Charles Gaber; Daniel Gillen; Debbie Gipson; Haoyu Gu; Susan M Hailpern; Yoshio N Hall; Yun Han; Kevin He; Paul Hebert; Margaret Helmuth; William Herman; Michael Heung; David Hutton; Steven J Jacobsen; Nan Ji; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Ronit Katz; Csaba P Kovesdy; Vivian Kurtz; Danielle Lavalee; Yi Li; Yee Lu; Keith McCullough; Miklos Z Molnar; Maria Montez-Rath; Hal Morgenstern; Qiao Mu; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Jeffrey Pearson; Ronald Pisoni; Brett Plattner; Friedrich K Port; Praveen Potukuchi; Panduranga Rao; Kaitlyn Ratkowiak; Vanessa Ravel; Debabrata Ray; Connie M Rhee; Douglas E Schaubel; David T Selewski; Sally Shaw; Jiaxiao Shi; Monica Shieu; John J Sim; Peter Song; Melissa Soohoo; Diane Steffick; Elani Streja; Manjula Kurella Tamura; Francesca Tentori; Anca Tilea; Lan Tong; Megan Turf; Dongyu Wang; Mia Wang; Kenneth Woodside; April Wyncott; Xin Xin; Wei Zang; Lindsay Zepel; Sai Zhang; Hui Zho; Richard A Hirth; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2017-03 Impact factor: 8.860
Authors: Daniel W White; Joseph C Wenke; Dan S Mosely; Sally B Mountcastle; Carl J Basamania Journal: Am J Sports Med Date: 2007-04-27 Impact factor: 6.202