Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study.

Meng-Hao Lin,Su-Ju Lin,Chi-Lung Chen,Wei-Hsiu Hsu,Pei-An Yu,Liang-Tseng Kuo,Tien-Hsing Chen,Yao-Hung Tsai

doi:10.3390/diagnostics11050822

Meng-Hao Lin, Su-Ju Lin + Show 6 more

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https://doi.org/10.3390/diagnostics11050822

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Abstract

The number of diabetic patients with chronic kidney disease (CKD) undergoing shoulder arthroplasty is growing. This study aims to compare perioperative outcomes of shoulder arthroplasty in diabetic patients at different renal function stages. Between 1998 and 2013, a total of 4443 diabetic patients with shoulder arthroplasty were enrolled: 1174 (26%) had CKD without dialysis (CKD group), 427 (9%) underwent dialysis (dialysis group), and 3042 (68%) had no CKD (non-CKD group). Compared with the non-CKD group, the CKD (odds ratio [OR], 4.69; 95% confidence interval [CI], 2.02–10.89) and dialysis (OR, 6.71; 95% CI, 1.63–27.73) groups had a high risk of in-hospital death. The dialysis group had a high risk of infection after shoulder arthroplasty compared with the CKD (subdistribution hazard ratio [SHR], 1.69; 95% CI, 1.07–2.69) and non-CKD (SHR, 1.76; 95% CI, 1.14–2.73) groups. The dialysis group showed higher risks of all-cause readmission and mortality than the CKD and non-CKD groups after a 3-month follow-up. In conclusion, CKD was associated with worse outcomes after shoulder arthroplasty. Compared with those without CKD, CKD patients had significantly increased readmission and mortality risks but did not have an increased risk of surgical complications, including superficial infection or implant removal.

Highlights

Over the past 20 years, shoulder arthroplasty (SA) procedures have rapidly increased by approximately four- to five-fold [1]
Shoulder hemiarthroplasty and anatomical total shoulder arthroplasty (ATSA) are indicated for shoulder end-stage arthritis, humeral head osteonecrosis, cuff tear arthropathy, and comminuted proximal humerus fracture
reverse total shoulder arthroplasty (RTSA) is indicated for irreparable rotator cuff tear arthropathy, revision procedures, and even comminuted proximal humerus fractures with low bone quality [4,5,6]

Summary

Introduction

Over the past 20 years, shoulder arthroplasty (SA) procedures have rapidly increased by approximately four- to five-fold [1]. Shoulder hemiarthroplasty and ATSA are indicated for shoulder end-stage arthritis, humeral head osteonecrosis, cuff tear arthropathy, and comminuted proximal humerus fracture. RTSA is indicated for irreparable rotator cuff tear arthropathy, revision procedures, and even comminuted proximal humerus fractures with low bone quality [4,5,6]. Common complications can be classified as surgical complications, including infection and loosening, and nonsurgical complications, including mortality and readmission. Patients with comorbidities such as chronic kidney disease (CKD) and diabetes mellitus (DM) have a high risk of unfavorable outcomes following joint arthroplasty [8,9,10,11,12,13].

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