Chronic Kidney Disease Is an Independent Risk Factor for Transfusion, Cardiovascular Complication, and Thirty-Day Readmission in Minimally Invasive Total Knee Arthroplasty

Background: Little is known about the relationship between chronic kidney disease (CKD) and minimally invasive total knee arthroplasty (MIS-TKA). We hypothesized that CKD was an independent risk factor for postoperative complications and increased blood transfusion in patients following MIS-TKA. Methods: A retrospective review of a prospective database was conducted on patients who underwent MIS-TKAs at an academic medical center between 2009 and 2012. Glomerular filtration rates (GFRs) were calculated for each patient at the time of surgery and a CKD group of 205 patients (GFR < 60 mL/min) were matched at a ratio of 1:2 with 410 patients showing a GFR >= 60 mL/min (control group). There were no differences between the 2 groups regarding age, gender, body mass index, and American Society of Anesthesiologists grade. Patient characteristics, comorbidities, preoperative hemoglobin, calculated total blood loss, transfusion rate, length of stay, and postoperative complications were compared between the 2 groups. Results: The CKD group had lower preoperative hemoglobin levels; higher preoperative comorbidities with cardiovascular disease, diabetes mellitus, and gout; longer length of stay; and higher total blood loss than the control group. Multivariate logistic regression showed that CKD was an independent risk factor for transfusions (odds ratio [OR] 7.6, 95% confidence interval [CI] 4.79-12.21, P<.001), cardiovascular complication (OR 5.5, 95% CI 1.68-9.39, P=.002), and 30-day readmission (OR 6.2, 95% CI 1.98-12.18, P=.005). Conclusion: Based on our data, CKD is an independent risk factor for blood transfusion, cardiovascular complication, and 30-day readmission in patients undergoing MIS-TKA. (C) 2016 Published by Elsevier Inc.