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Kidney dysfunction is a significant risk factor for 30-day postoperative complications following shoulder arthroplasty

Abstract:

Background: The objective of this study was to investigate estimated glomerular filtration rate levels as an independent risk factor for short-term complications within 30 days of shoulder arthroplasty (SA). Methods: The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent SA between 2015 and 2019. The study population was then divided into 6 cohorts based on estimated glomerular filtration rate values of <15 (stage 5 CKD), 15-30 (stage 4 CKD), 30-60 (stage 3 CKD), 60-90, 90-120 (reference cohort), and 120-155. Multivariate logistic regression was conducted to investigate the association between glomerular function and postoperative complications within 30 days of SA. Major complications included cardiac, renal, and respiratory complications, as well as reoperation, readmission, and mortality. Minor complications included urinary tract infection, pneumonia, and transfusion within 72 hours. Results: This study included a total of 19,681 patients. An increasing rate of overall complications was observed as the severity of CKD progressed from stage 3 (9.9%) to stage 4 (21.2%) and to stage 5 (21.3%). A similar pattern was seen for major complications (6.2%, 10.3%, 11.7%), minor complications (5.3%, 13.0%, 13.8%), and postoperative anemia requiring transfusion (3.2%, 10.3%, 10.6%). An adjusted multivariate logistic regression analysis showed that the stage 5 CKD cohort had a greater risk of developing the following complications than the reference cohort: overall complications (odds ratio [OR], 3.6; P =.015), minor complications (OR, 5.8; P =.003), renal complications (OR, 27.2; P =.005), and postoperative anemia requiring transfusion (OR, 12.8; P <.001). The stage 4 CKD cohort was also observed to have a greater risk of developing the following complications than the reference group: overall complications (OR, 2.6; P <.001), minor complications (OR, 2.9; P <.001), postoperative anemia requiring transfusion (OR, 4.5; P <.001), nonhome discharge (OR, 1.6; P =.026), and hospital readmission (OR, 2.2; P =.015). Similarly, the stage 3 CKD cohort had a greater risk of developing the following complications than the reference group: overall complications (OR, 1.3; P =.004), major complications (OR, 1.3; P =.035), minor complications (OR, 1.3; P =.038), postoperative anemia requiring transfusion (OR, 1.5; P =.014), and hospital readmission (OR, 1.3; P =.028). Conclusion: This study identified a significant association between increasing severity of CKD (from stage 3 to 5) and increased overall complication rates within 30 days of SA. Patients with the stage 5 CKD cohort status had much higher odds of developing minor complications, overall complications, and postoperative anemia requiring transfusion than those with earlier stages of CKD (stage 3 and 4).