Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.

Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.

<h4>Background</h4>The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aime...

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Autores principales: Chien-Tien Chen, Su-Ju Lin, Liang-Tseng Kuo, Tien-Hsing Chen, Wei-Hsiu Hsu, Chi-Lung Chen, Pei-An Yu, Kuo-Ti Peng, Yao-Hung Tsai
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
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Medicine
R
Science
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Acceso en línea:https://doaj.org/article/6035ea894dec4630b4d7295835501126
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spelling oai:doaj.org-article:6035ea894dec4630b4d72958355011262021-12-02T20:17:08ZEffect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.1932-620310.1371/journal.pone.0258393https://doaj.org/article/6035ea894dec4630b4d72958355011262021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258393https://doaj.org/toc/1932-6203<h4>Background</h4>The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aimed to investigate and compare early and late outcomes following proximal humerus fracture fixation surgery in diabetic patients with different renal function conditions.<h4>Methods</h4>DM patients receiving PHF fixation surgery during 1998-2013 were recruited from Taiwan's National Health Insurance Research Database. According to their renal function, patients were divided into three study groups: non-chronic kidney disease (CKD), non-dialysis CKD, and dialysis. Outcomes of interest were early and late perioperative outcomes. Early outcomes included in-hospital newly-onset morbidities. Late outcomes included infection, revision, readmission, and all-cause mortality.<h4>Results</h4>This study included a total of 10,850 diabetic patients: 2152 had CKD (non-dialysis CKD group), 196 underwent permanent dialysis (dialysis group), and the remaining 8502 did not have CKD (non-CKD group). During a mean follow-up of 5.56 years, the dialysis group showed the highest risk of overall infection, all-cause revision, readmission, and mortality compared to the non-dialysis CKD group and non-CKD group. Furthermore, subgroup analysis showed that CKD patients had a higher risk of surgical infection following PHF surgery than non-CKD patients in cases with a traffic accident or fewer comorbidities (Charlson Comorbidity Index, CCI <3) (P for interaction: 0.086 and 0.096, respectively). Also, CKD patients had an even higher mortality risk after PHF surgery than non-CKD patients, in females, those living in higher urbanization areas, or with more comorbidities (CCI ≥3) (P for interaction: 0.011, 0.057, and 0.069, respectively).<h4>Conclusion</h4>CKD was associated with elevated risks for infection, revision, readmission, and mortality after PHF fixation surgery in diabetic patients. These findings should be taken into consideration when caring for diabetic patients.Chien-Tien ChenSu-Ju LinLiang-Tseng KuoTien-Hsing ChenWei-Hsiu HsuChi-Lung ChenPei-An YuKuo-Ti PengYao-Hung TsaiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258393 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Chien-Tien Chen
Su-Ju Lin
Liang-Tseng Kuo
Tien-Hsing Chen
Wei-Hsiu Hsu
Chi-Lung Chen
Pei-An Yu
Kuo-Ti Peng
Yao-Hung Tsai
Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
description <h4>Background</h4>The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aimed to investigate and compare early and late outcomes following proximal humerus fracture fixation surgery in diabetic patients with different renal function conditions.<h4>Methods</h4>DM patients receiving PHF fixation surgery during 1998-2013 were recruited from Taiwan's National Health Insurance Research Database. According to their renal function, patients were divided into three study groups: non-chronic kidney disease (CKD), non-dialysis CKD, and dialysis. Outcomes of interest were early and late perioperative outcomes. Early outcomes included in-hospital newly-onset morbidities. Late outcomes included infection, revision, readmission, and all-cause mortality.<h4>Results</h4>This study included a total of 10,850 diabetic patients: 2152 had CKD (non-dialysis CKD group), 196 underwent permanent dialysis (dialysis group), and the remaining 8502 did not have CKD (non-CKD group). During a mean follow-up of 5.56 years, the dialysis group showed the highest risk of overall infection, all-cause revision, readmission, and mortality compared to the non-dialysis CKD group and non-CKD group. Furthermore, subgroup analysis showed that CKD patients had a higher risk of surgical infection following PHF surgery than non-CKD patients in cases with a traffic accident or fewer comorbidities (Charlson Comorbidity Index, CCI <3) (P for interaction: 0.086 and 0.096, respectively). Also, CKD patients had an even higher mortality risk after PHF surgery than non-CKD patients, in females, those living in higher urbanization areas, or with more comorbidities (CCI ≥3) (P for interaction: 0.011, 0.057, and 0.069, respectively).<h4>Conclusion</h4>CKD was associated with elevated risks for infection, revision, readmission, and mortality after PHF fixation surgery in diabetic patients. These findings should be taken into consideration when caring for diabetic patients.
format article
author Chien-Tien Chen
Su-Ju Lin
Liang-Tseng Kuo
Tien-Hsing Chen
Wei-Hsiu Hsu
Chi-Lung Chen
Pei-An Yu
Kuo-Ti Peng
Yao-Hung Tsai
author_facet Chien-Tien Chen
Su-Ju Lin
Liang-Tseng Kuo
Tien-Hsing Chen
Wei-Hsiu Hsu
Chi-Lung Chen
Pei-An Yu
Kuo-Ti Peng
Yao-Hung Tsai
author_sort Chien-Tien Chen
title Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
title_short Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
title_full Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
title_fullStr Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
title_full_unstemmed Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.
title_sort effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: a nationwide population-based cohort study.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/6035ea894dec4630b4d7295835501126
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