ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicManagement of Patients with Dialysis Dependent Chronic Kidney Disease (DD-CKD)View all 12 articles
Excess Risk and Resource Utilization in Dialysis-Dependent Patients Undergoing Total Hip Arthroplasty: Insights From a Nationally Representative Database
Provisionally accepted
- 1Technion Israel Institute of Technology The Technion Genome Center, Haifa, Israel
- 2Carmel Medical Center, Haifa, Israel
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ABSTRACT: Background : Total hip arthroplasty (THA) reliably restores function and quality of life in patients with end-stage hip disease. Individuals with end-stage renal disease (ESRD) requiring dialysis are vulnerable to perioperative complications due to immune dysfunction, hemodynamic instability, and impaired wound healing. Evidence on risk-adjusted outcomes remains limited. Methods : A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2022). Dialysis dependence was identified using ICD-10-CM Z99.2. Primary outcomes included in-hospital mortality, length of stay (LOS), and hospital charges; secondary outcomes were major complications. Propensity score matching (10:1 nearest neighbour) balanced baseline demographics and comorbidities. Survey weights were used for national estimates. Post-matching outcomes were compared using risk ratios (RR) with 95% CIs. Results : Among 1,957,284 THA patients, 2,730 (0.1%) were dialysis dependent. In unmatched analysis, dialysis dependence was associated with substantially increased in-hospital mortality (1.3% vs. 0.03%; crude RR 31.9, 95% CI 22.7–44.9). After 10:1 propensity-score matching, dialysis-dependent patients had 62.5% longer LOS (3.9 vs. 2.4 days, p < 0.01), 95.8% higher hospital charges ($98,454 vs. $60,741, p < 0.01), and persistently elevated in-hospital mortality (matched RR 10.1, 95% CI 6.3–16.2). Major complications were significantly more frequent. Conclusion : Dialysis dependence is a strong independent predictor of higher perioperative morbidity, mortality, and cost following THA. Targeted multidisciplinary optimization and enhanced perioperative care pathways are warranted. Level of Evidence: Level III (Retrospective Cohort Study).
Keywords: end-stage renal disease, Healthcare costs, In-hospital mortality, Length of Stay, Postoperative Complications, Renal Dialysis, Total hip arthroplasty
Received: 13 Sep 2025; Accepted: 10 Dec 2025.
Copyright: © 2025 Maman, Steinfeld1 and Berkovich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: David Maman
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