The Influence of Renal Dialysis on All-Cause Mortality in Older Patients with Hip Fracture: a Korean Nationwide Cohort Study

Abstract

Background: The purpose of this study was to analyze the all-cause mortality rate over time after elderly hip fracture in end-stage renal disease (ESRD) patients with dialysis, using a Korean nationwide claims database. Methods: This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Senior cohort (NHIS-Senior). The NHIS-Senior (total of 588,147 participants) was constructed by 10% random sampling and was designed to represent the elderly living in Korea. Subjects were patients aged 65-99 years who underwent surgical treatment for femoral neck fractures or intertrochanteric fractures. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to measure associations between renal dialysis and cumulative mortality in various time frames. Results: The total number of patients included in this study was 16,818. These patients were divided into two groups: 116 (0.69%) in the dialysis group and 16,702 (99.31%) in the no-dialysis group. The mean length of hospital stay was 43.87 ± 48.45 days in the dialysis group and 36.29 ± 37.49 days in the no-dialysis group (P = 0.095). The effect of renal dialysis on all-cause mortality was 2.29-fold (aRR; 95% CI, 1.29-4.06; P = 0.005) within 30 days and 1.72-fold (aRR; 95% CI, 1.34-2.21; P < 0.001) within 1-year after hip fracture compared to the no-dialysis group. And, the effect of renal dialysis of in-hospital mortality was 2.72-fold (aRR; 95% CI, 1.71-4.33; P < 0.001) compared to the no-dialysis group. Conclusion: Elderly patients who underwent dialysis have very high mortality rates after hip fracture. Therefore, it is considered that postoperative care through multidisciplinary management and understanding of pathophysiology for the ESRD patients is necessary.

Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study

“…In concurrence with studies that have reported predictors of mortality risk following hip surgery, 17,34,36,37 our study also demonstrated that male sex, high preoperative serum creatinine, low baseline handgrip strength, and high CCI were poor indictors of a high risk of mortality within 1 year of hip surgery in the geriatric population. In addition, long surgical delay after a falling accident was an important predictor for mortality risk in this study.…”

RETRACTED: The impact of chronic kidney disease and dialysis therapy on outcomes of elderly patients with hip fractures: A systematic review and meta-analysis

“…All of the included studies were retrospective cohort studies. 26,[28][29][30][31][32][33][39][40][41][42] The data is summarized in Table 1.…”

“…Two studies reported age as the range. 26,39 Here, the age of the patients with chronic kidney disease not undergoing hemodialysis was 76.9 ± 2.5 years, whereas for the patients with chronic kidney disease undergoing hemodialysis the average age was 73.6 ± 3.3 years. The average age of healthy participants was 75.3 ± 2.6 years.…”

Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures

“…Nevertheless, our results are consistent with the hip fracture literature, which found that patients with ESRD are at higher risk for readmission and complications after surgery. 9 , 17 , 19 , 22 , 23 , 41 When examining specific causes for 90-day readmission, SSI was the most common in both cohorts. Interestingly, there was no concurrent increased risk of reoperation, suggesting these were likely superficial SSI amenable to antibiotics.…”

“…ESRD is associated with increased mortality, medical complications, readmission, and revision surgery in hip fractures. 17 , 23 , 32 , 41 More generally, renal disease has been associated with increased rates of postoperative infection, osteonecrosis, nonunion, and implant failure. 9 , 19 , 22 …”