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Abstract: SU-OR26

Cardiovascular Thromboembolic Outcomes by Dialysis Modality Following Primary Total Knee Arthroplasty

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Valdes Sanchez, Chavely, University of Miami at Holy Cross Hospital, Fort Lauderdale, Florida, United States
  • Lozier, Matthew R., University of Miami at Holy Cross Hospital, Fort Lauderdale, Florida, United States
  • Tellez, Mauricio, University of Miami at Holy Cross Hospital, Fort Lauderdale, Florida, United States
  • Sanchez, Alexandra M., University of Miami at Holy Cross Hospital, Fort Lauderdale, Florida, United States
  • Valle, Gabriel A., The Kidney and Hypertension Group of South Florida, Fort Lauderdale, Florida, United States
Background

There is a paucity in the literature evaluating the impact of dialysis modalities on cardiovascular thromboembolic outcomes following primary total knee arthroplasty (TKA). Therefore, the purpose of this study was to investigate whether patients treated with hemodialysis (HD) or peritoneal dialysis (PD) have higher rates of: 1) medical complications, 2) readmission, and 3) cost of care.

Methods

Patients undergoing primary TKA while receiving HD served as the study group (n = 82,518) and matched 1:1 to a control group of PD patients (n = 82,518) by distribution, age, sex, and Elixhauser-Comorbidity Index (ECI). Outcomes analyzed included rates of 90-day medical complications, readmission rates, and cost of care. Logistic regression analysis was used to calculate odds-ratios (OR) for medical complications and readmission rates. Welch’s t-test was used to test for significance on cost of care and ECI between cohorts. P-value less than 0.05 was considered statistically significant.

Results

Patients undergoing HD prior to primary TKA were found to have a significantly lower incidence and odds of cerebrovascular accidents (PD vs. HD: 0.19 vs. 0.13%; OR: 1.44, p=0.003) and venous thromboemboli (0.15 vs. 0.10%; OR: 1.52, p<0.001), specifically deep vein thromboses (0.13 vs 0.10%; OR 1.75, p<0.001). HD patients did however incur significantly higher 90-day cost of care ($104,341.89 vs. $209,611.67; p<0.001). No statistically significant differences were noted in myocardial infarction, pulmonary embolism, or 90-day readmission rates between the two groups.

Conclusion

While incurring a lower 90-day cost of care, patients treated with PD prior to primary TKA may have a greater odds of developing a cerebrovascular accident or deep vein thrombosis when compared to HD.

Table 1
Cardiovascular Thromboembolic Adverse OutcomesIncidence (PD vs. HD)Odds Ratio95% Confidence IntervalP-Value
Myocardial Infarction0.14 vs. 0.13%1.110.85 - 1.450.42
Cerebrovascular Accident0.19 vs. 0.13%1.441.13 - 1.830.003
Venous Thromboembolism0.15 vs. 0.10%1.521.15 - 2.000.0003
Deep Vein Thrombosis0.13 vs. 0.10%1.751.28 - 2.40<0.001
Pulmonary Embolism0.02 vs. 0.03%0.860.46 - 1.590.64
     
Readmission Rates & Cost of Care at 90 DaysIncidence (PD vs. HD)Odds Ratio95% Confidence IntervalP-Value
Readmission Rates51.94 vs. 51.62%1.010.99 - 1.030.18
Cost of Care$104,341.89 vs. $209,611.67  <0.0001

Outcome comparisons by dialysis modality following TKA.