Abstract: SU-OR26
Cardiovascular Thromboembolic Outcomes by Dialysis Modality Following Primary Total Knee Arthroplasty
Session Information
- Peritoneal Dialysis and Vascular Access: Research Abstracts
October 25, 2020 | Location: Simulive
Abstract Time: 05:00 PM - 07:00 PM
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 Outcomes | Incidence (PD vs. HD) | Odds Ratio | 95% Confidence Interval | P-Value |
| Myocardial Infarction | 0.14 vs. 0.13% | 1.11 | 0.85 - 1.45 | 0.42 |
| Cerebrovascular Accident | 0.19 vs. 0.13% | 1.44 | 1.13 - 1.83 | 0.003 |
| Venous Thromboembolism | 0.15 vs. 0.10% | 1.52 | 1.15 - 2.00 | 0.0003 |
| Deep Vein Thrombosis | 0.13 vs. 0.10% | 1.75 | 1.28 - 2.40 | <0.001 |
| Pulmonary Embolism | 0.02 vs. 0.03% | 0.86 | 0.46 - 1.59 | 0.64 |
| Readmission Rates & Cost of Care at 90 Days | Incidence (PD vs. HD) | Odds Ratio | 95% Confidence Interval | P-Value |
| Readmission Rates | 51.94 vs. 51.62% | 1.01 | 0.99 - 1.03 | 0.18 |
| Cost of Care | $104,341.89 vs. $209,611.67 | <0.0001 |
Outcome comparisons by dialysis modality following TKA.