Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients With End-Stage Renal Disease

被引:14
|
作者
Humbyrd, Casey Jo [1 ]
Bae, Sunjae [2 ,3 ]
Kucirka, Lauren M. [2 ]
Segev, Dorry L. [2 ,3 ]
机构
[1] Johns Hopkins Sch Med, Dept Orthopaed Surg, Baltimore, MD USA
[2] Johns Hopkins Sch Med, Dept Surg, Baltimore, MD USA
[3] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
关键词
Achilles tendon rupture; dialysis; end-stage renal disease; kidney transplant; TRANSPLANT RECIPIENT; INCREASING INCIDENCE; UNITED-STATES; EPIDEMIOLOGY; POPULATION; DIALYSIS; SURGERY; INJURY;
D O I
10.1177/1071100718762089
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR). Methods: We studied Medicare patients with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted for a transplant, not waitlisted, or received a transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, and year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR risk factors, and determine treatment patterns and outcomes. Results: We identified 1091 ATRs (incidence, 3.80/10 000 person-years; 95% confidence interval [CI], 3.58-4.03). Compared with transplant recipients, nonwaitlisted patients had a lower incidence (aIRR, 0.44; 95% CI, 0.37-0.53), and waitlisted patients had a similar incidence (aIRR, 0.94; 95% CI, 0.78-1.12) of ATR. ATR incidence was higher among patients taking fluoroquinolones (aIRR, 1.65; 95% CI, 1.32-1.84) and corticosteroids (aIRR, 1.72; 95% CI, 1.44-2.05) compared with those who did not. Patients with ATR were younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Seventeen percent of patients received operative treatment within 14 days of ATR diagnosis. The 30-day cumulative incidence of operative site infections was 6.5%. Conclusion: The incidence of ATR was higher among transplant recipients and waitlisted patients compared with nonwaitlisted patients. Younger age, higher body mass index, fewer comorbidities, fluoroquinolone use, and corticosteroid use were risk factors for ATR. Patients were more likely to receive nonoperative than operative treatment for ATR. Those who underwent operative treatment had a low incidence of operative site infection. Level of Evidence: Prognostic level III, comparative study.
引用
收藏
页码:821 / 828
页数:8
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