Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders.

With a growing prevalence for chronic renal failure, arthroplasty surgeons will find it more likely to have dialysis dependent patients present for knee replacement. Previous retrospective studies using a matched cohort of patients have reported worse perioperative outcomes for dialysis-dependent patients. However, many of these studies failed to control for pertinent confounders. This study aims to fill in that void. The present study compares lengths of stay, discharge status, and 30-day outcomes between dialysis-dependent TKA recipients and a matched cohort of nondialysis dependent TKA recipients. The National Surgical Quality Improvement Program database was used to identify the study cohorts. Patients were propensity score matched based on patient-specific demographic variables, preoperative functional status, and preoperative laboratory values. Generalized regression models were conducted to assess the effects of dialysis dependency on perioperative outcomes. Dialysis dependent patients demonstrated longer mean lengths of stay (+1.14) and a lower likelihood for home discharge (odds ratio [OR] = 0.503). There was no increased risk of 30-day complications in dialysis dependent TKA patients. Our findings demonstrate no increased risk of 30-day complications after TKA when adjusting for pertinent confounders. This suggests TKA is safe for well optimized dialysis dependent patients prior to surgery.

Adjunctive Intravenous Diclofenac Decreases Opioid Consumption and Increases Satisfaction in the Primary Total Hip Arthroplasty Population.

Despite the success of total hip arthroplasty (THA), postoperative pain management remains a concern. Although the nonsteroidal anti-inflammatory drug (NSAID) intravenous (IV) diclofenac is a promising addition, its impact on THA outcomes has not been investigated. This study evaluates the effects of adjunctive IV diclofenac on: 1) postoperative pain intensity; 2) opioid consumption; 3) discharge destination; 4) length of stay; and 5) patient satisfaction in primary THA patients. A retrospective study was performed for patients who underwent primary THA by a single surgeon between May 1 and September 31, 2017. Patients of the study group (n=25) were treated postoperatively with IV diclofenac and the standard pain control regimen while the control group (n=88) did not receive diclofenac. Patients receiving adjunctive IV diclofenac were more likely to be discharged home than to inpatient facilities (O.R. 4.02; p=0.049). Patient satisfaction with respect to how well and how often pain was controlled (p= 0.0436 and p=0.0217, respectively) was significantly greater in the IV diclofenac group. Patients who received IV diclofenac had lower opioid consumption on postoperative days one and two (-67.2 and -129.0mg, respectively; p=0.001 for both). The growth of THA as an outpatient procedure has intensified the urgency of improving postoperative pain management. This study demonstrates that THA patients receiving adjunctive IV diclofenac were more likely to be discharged home, had reduced opioid consumption, and experienced greater satisfaction. To further investigate the optimal regimen, future studies comprising a larger cohort and comparing IV diclofenac to other NSAIDs are warranted.