Geriatric patients who require kidney dialysis are almost twice as likely as patients without dialysis to face complications following hip fracture surgery, a new study by Yale researchers finds.
The study published in the August issue of the Journal of the American Academy of Orthopaedic Surgeons Global Research & Reviews, completed by researchers in the Yale Department of Orthopaedics and Rehabilitation, found that dialysis patients over age 60 requiring surgery for hip fracture were more likely to suffer from complications than those who were not, even when taking into account other factors.
The lead author of the paper was Yale School of Medicine Student Taylor Ottesen, who worked with other Yale students including Alp Yurter, Blake Shultz, Anoop Galivanche, Cheryl Zogg, and Patawut Bovonratwet, in partnership with faculty mentors Lee Rubin, MD, and Jonathan Grauer, MD.
“The dialysis dependent population is continuing to rise in the United States,” they wrote. “This is particularly relevant to orthopaedic surgeons because of an increased risk for fractures and a decreased potential for healing after such injuries in this population.”
The researchers used the National Surgical Quality Improvement Program (NSQIP) database from the American College of Surgeons (ACS), which provides national information regarding the 30-day outcomes of post-operative patients. They looked over 16,000 patients who required surgery for hip fracture, of which 288 (1.7 percent) were on dialysis. Of those not on dialysis, 23.1 percent suffered varying short term adverse events, compared with a 39.5 percent complication rate seen in the dialysis patient group.
The study was distinctive based on the number of patients studied for the questions being asked. Dr. Grauer, a senior author of the paper, noted that “dialysis patients can have other medical issues, but the current study controlled for demographics and health status, showing that geriatric dialysis patients undergoing surgery for hip fracture were at greater odds of short-term adverse events, even when controlling for such other factors.”
The types and timing of adverse outcomes were studied. Dr. Rubin, another senior author of the paper, noted “The findings of this study are important not only for orthopaedic surgeons to be aware of, but also impact the other clinicians and caregivers involved in a patient’s recovery. Early surveillance of a patient on dialysis undergoing hip fracture surgery may be critical to ensuring their long-term outcomes.”
Furthermore, the data is important for patient and family education, hospital care planning, and may impact national healthcare policy regarding risk-adjustment for bundled care episodes. Patients with end-stage renal disease who are managed with dialysis have an increased risk for fracture and a decreased potential for healing after surgery, so heightened surveillance is needed throughout the perioperative period in this high-risk patient population, they wrote.