Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Covariates
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. In-Hospital Outcomes
3.3. Late Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Non-CKD (n = 3042) | Non-Dialysis CKD (n = 1174) | Dialysis (n = 227) | p-Value |
---|---|---|---|---|
Age (years) | 69.6 ± 11.9 | 71.8 ± 10.6 a | 65.4 ± 10.3 a,b | <0.001 |
Age group | ||||
<60 yrs. | 682 (22.4) | 173 (14.7) a | 83 (36.6) a,b | <0.001 |
60–80 yrs. | 1766 (58.1) | 745 (63.5) a | 125 (55.1) | |
>80 yrs. | 594 (19.5) | 256 (21.8) | 19 (8.4) b | |
Female sex | 2112 (69.4) | 831 (70.8) | 144 (63.4) | 0.088 |
Hospital level | ||||
Medical center | 1134 (37.3) | 411 (35.0) | 91 (40.1) | 0.041 |
Region hospital | 1268 (41.7) | 537 (45.7) | 102 (44.9) | |
District hospital or clinics | 640 (21.0) | 226 (19.3) | 34 (15.0) | |
Hospital volume (surgeries) | 0.013 | |||
Q1 (1–130) | 764 (25.1) | 287 (24.4) | 46 (20.3) | |
Q2 (132–262) | 772 (25.4) | 278 (23.7) | 58 (25.6) | |
Q3 (281–544) | 762 (25.0) | 313 (26.7) | 81 (35.7) b | |
Q4 (598–1427) | 744 (24.5) | 296 (25.2) | 42 (18.5) | |
Monthly income, USD | 0.130 | |||
≤$596 | 1095 (36.0) | 414 (35.3) | 70 (30.8) | |
$597–$760 | 1236 (40.6) | 510 (43.4) | 94 (41.4) | |
>$760 | 711 (23.4) | 250 (21.3) | 63 (27.8) | |
Urbanization level | 0.401 | |||
Low | 437 (14.4) | 192 (16.4) | 33 (14.5) | |
Moderate | 1002 (32.9) | 366 (31.2) | 77 (33.9) | |
High | 917 (30.1) | 333 (28.4) | 60 (26.4) | |
Very high | 686 (22.6) | 283 (24.1) | 57 (25.1) | |
Duration of surgery | 0.133 | |||
≤4 h | 880 (28.9) | 362 (30.8) | 77 (33.9) | |
>4 h | 2162 (71.1) | 812 (69.2) | 150 (66.1) | |
Comorbidity | ||||
Stroke | 463 (15.2) | 253 (21.6) a | 56 (24.7) a | <0.001 |
COPD | 264 (8.7) | 158 (13.5) a | 18 (7.9) | <0.001 |
Heart failure | 534 (17.6) | 323 (27.5) a | 85 (37.4) a,b | <0.001 |
Coronary heart disease | 556 (18.3) | 380 (32.4) a | 76 (33.5) a | <0.001 |
Hyperlipidemia | 706 (23.2) | 353 (30.1) a | 46 (20.3) b | <0.001 |
Cardiac dysrhythmia | 212 (7.0) | 113 (9.6) a | 22 (9.7) | 0.009 |
Myocardial infarction | 175 (5.8) | 117 (10.0) a | 30 (13.2) a | <0.001 |
Hypertension | 2026 (66.6) | 933 (79.5) a | 187 (82.4) a | <0.001 |
Dementia | 221 (7.3) | 113 (9.6) a | 11 (4.8) | 0.009 |
Osteoporosis | 1426 (46.9) | 577 (49.1) | 142 (62.6) b | <0.001 |
CCI score | 2.0 ± 2.0 | 3.0 ± 2.0 a | 5.0 ± 2.0 a,b | <0.001 |
Follow up duration (years) | 5.5 ± 3.9 | 3.8 ± 3.0 a | 2.7 ± 2.3 a,b | <0.001 |
Number of Events (%) | Adjusted OR or β ‡ | ||||||||
---|---|---|---|---|---|---|---|---|---|
Outcome | Non-CKD (n = 3042) | Non-Dialysis CKD (n = 1174) | Dialysis (n = 227) | Non-Dialysis CKD vs. Non-CKD | Dialysis vs. Non-CKD | Dialysis vs. Non-Dialysis CKD | |||
OR or β (95% CI) | p-Value | OR or β (95% CI) | p-Value | OR or β (95% CI) | p-Value | ||||
Categorical | |||||||||
Newly-onset VTE | 7 (0.23) | 4 (0.34) | 0 (0) | 1.68 (0.46–6.20) | 0.436 | NA | NA | NA | NA |
Delirium | 5 (0.16) | 4 (0.34) | 0 (0) | 1.76 (0.40–7.78) | 0.455 | NA | NA | NA | NA |
Debridement | 44 (1.45) | 16 (1.36) | 0 (0) | 1.02 (0.56–1.86) | 0.949 | NA | NA | NA | NA |
Infection | 76 (2.5) | 23 (2.0) | 2 (0.88) | 0.87 (0.53–1.42) | 0.573 | 0.39 (0.09–1.63) | 0.196 | 0.45 (0.10–1.96) | 0.284 |
UTI | 106 (3.5) | 56 (4.8) | 5 (2.2) | 1.16 (0.82–1.64) | 0.391 | 0.58 (0.23–1.49) | 0.258 | 0.50 (0.20–1.29) | 0.153 |
Pneumonia | 50 (1.6) | 28 (2.4) | 2 (0.88) | 1.19 (0.73–1.94) | 0.492 | 0.66 (0.15–2.82) | 0.569 | 0.55 (0.13–2.40) | 0.428 |
Transfusion | 1922 (63.2) | 897 (76.4) | 186 (81.9) | 1.87 (1.59–2.21) | <0.001 | 2.98 (2.07–4.30) | <0.001 | 1.59 (1.09–2.33) | 0.016 |
ICU stay | 106 (3.5) | 83 (7.1) | 15 (6.6) | 1.68 (1.23–2.29) | 0.001 | 1.79 (0.98–3.26) | 0.058 | 1.07 (0.58–1.95) | 0.833 |
In-hospital death | 9 (0.29) | 17 (1.4) | 3 (1.3) | 4.69 (2.02–10.89) | <0.001 | 6.71 (1.63–27.73) | 0.009 | 1.43 (0.38–5.35) | 0.595 |
Continuous | |||||||||
Hospital days | 10.0 ± 9.0 | 12.0 ± 11.0 | 12.0 ± 10.0 | 1.79 (1.13–2.45) | <0.001 | 2.29 (0.96–3.61) | 0.001 | 0.50 (−0.89–1.88) | 0.481 |
Cost (USD × 103) | 3.6 ± 2.4 | 4.2 ± 4.0 | 4.5 ± 2.4 | 0.47 (0.27, 0.67) | <0.001 | 0.85 (0.45, 1.26) | <0.001 | 0.38 (−0.04, 0.80) | 0.077 |
Number of Events (%) | Adjusted Hazard Ratio and 95% CI ‡ | ||||||||
---|---|---|---|---|---|---|---|---|---|
Outcome | Non-CKD (n = 3042) | Non-Dialysis CKD (n = 1174) | Dialysis (n = 227) | Non-Dialysis CKD vs. Non-CKD | Dialysis vs. Non-CKD | Dialysis vs. Non-Dialysis CKD | |||
HR or SHR (95% CI) | p-Value | HR or SHR (95% CI) | p-Value | HR or SHR (95% CI) | p-Value | ||||
Infection | |||||||||
Superficial infection | 169 (5.6) | 61 (5.3) | 18 (8.0) | 1.14 (0.83–1.56) | 0.416 | 1.63 (0.97–2.75) | 0.067 | 1.43 (0.83–2.47) | 0.197 |
Debridement | 59 (1.9) | 16 (1.4) | 6 (2.7) | 0.94 (0.52–1.70) | 0.842 | 1.43 (0.59–3.50) | 0.431 | 1.52 (0.58–4.02) | 0.398 |
Implant removal | 72 (2.4) | 23 (2.0) | 6 (2.7) | 1.09 (0.67–1.75) | 0.738 | 1.34 (0.58–3.10) | 0.501 | 1.23 (0.51–2.96) | 0.642 |
Any infection | 228 (7.5) | 75 (6.5) | 26 (11.6) | 1.04 (0.79–1.37) | 0.780 | 1.76 (1.14–2.73) | 0.011 | 1.69 (1.07–2.69) | 0.025 |
All-cause readmission | |||||||||
At 30 days | 293 (9.7) | 170 (14.7) | 30 (13.4) | 1.39 (1.15–1.70) | 0.001 | 1.28 (0.85–1.92) | 0.234 | 0.92 (0.61–1.38) | 0.679 |
At 90 days | 565 (18.6) | 306 (26.4) | 76 (33.9) | 1.33 (1.15–1.54) | <0.001 | 1.62 (1.27–2.09) | <0.001 | 1.22 (0.95–1.58) | 0.125 |
At 1 year | 1138 (37.5) | 609 (52.6) | 141 (62.9) | 1.42 (1.29–1.58) | <0.001 | 1.74 (1.46–2.08) | <0.001 | 1.22 (1.02–1.47) | 0.031 |
At the end | 2382 (78.5) | 933 (80.6) | 186 (83.0) | 1.33 (1.23–1.44) | <0.001 | 1.72 (1.49–1.98) | <0.001 | 1.29 (1.11–1.50) | 0.001 |
All-cause mortality | |||||||||
At 30 days | 24 (0.79) | 33 (2.8) | 7 (3.1) | 3.33 (1.93–5.75) | <0.001 | 4.82 (1.95–11.89) | 0.001 | 1.45 (0.61–3.43) | 0.402 |
At 90 days | 62 (2.0) | 58 (4.9) | 18 (7.9) | 2.22 (1.53–3.21) | <0.001 | 4.74 (2.69–8.36) | <0.001 | 2.14 (1.22–3.76) | 0.008 |
At 1 year | 199 (6.5) | 148 (12.6) | 43 (18.9) | 1.83 (1.47–2.28) | <0.001 | 3.56 (2.50–5.06) | <0.001 | 1.95 (1.36–2.78) | 0.000 |
At the end | 1191 (39.2) | 555 (47.3) | 143 (63.0) | 1.62 (1.45–1.80) | <0.001 | 4.07 (3.39–4.90) | <0.001 | 2.52 (2.08–3.05) | <0.001 |
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Lin, M.-H.; Lin, S.-J.; Kuo, L.-T.; Chen, T.-H.; Chen, C.-L.; Yu, P.-A.; Tsai, Y.-H.; Hsu, W.-H. Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study. Diagnostics 2021, 11, 822. https://doi.org/10.3390/diagnostics11050822
Lin M-H, Lin S-J, Kuo L-T, Chen T-H, Chen C-L, Yu P-A, Tsai Y-H, Hsu W-H. Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study. Diagnostics. 2021; 11(5):822. https://doi.org/10.3390/diagnostics11050822
Chicago/Turabian StyleLin, Meng-Hao, Su-Ju Lin, Liang-Tseng Kuo, Tien-Hsing Chen, Chi-Lung Chen, Pei-An Yu, Yao-Hung Tsai, and Wei-Hsiu Hsu. 2021. "Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study" Diagnostics 11, no. 5: 822. https://doi.org/10.3390/diagnostics11050822