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Zhu H, Ren A, Zhou K, Chen Q, Zhang M, Liu J. Impact of Dexmedetomidine Infusion on Postoperative Acute Kidney Injury in Elderly Patients Undergoing Major Joint Replacement: A Retrospective Cohort Study. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:4695-4701. [PMID: 33173279 PMCID: PMC7646437 DOI: 10.2147/dddt.s278342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Purpose Postoperative acute kidney injury (AKI) is a frequent complication in elderly patients that increases morbidity and mortality. Approximately 1.7 million people die from AKI worldwide every year. Dexmedetomidine (Dex) is often used as an adjunct to multimodal analgesia. Our study investigated whether Dex could safely decrease the incidence of AKI in elderly patients undergoing major joint replacement. Methods A single-center retrospective study was conducted in patients aged >65 years undergoing major joint replacement. Propensity score–matching analysis was used, and a total of 1,006 patients were matched successfully. The primary outcome was the incidence of postoperative AKI. Secondary outcomes included perioperative adverse complications, opioid consumption, time to extubation, and length of hospital stay. Results Among the 1,006 patients included, postoperative AKI occurred in 9.3% (n=94). The Dex group (perioperative Dex infusion) had lower incidence of postoperative AKI than the control group (7.2% vs 11.5%, P=0.017). Compared with the control group, the Dex group had less opioid consumption (P<0.05), reduced time to extubation (P=0.004), and shorter length of hospital stay (P=0.001). The Dex group also showed higher incidence of bradycardia (20.1% vs 15.1%, P=0.038). There were no differences in intraoperative hypotension (19.5% vs 17.5%), postoperative nausea and vomiting (4.2% vs 5.4%), time in PACU (45.0±6.4 vs 45.5±6.2 minutes), or rate of ICU admission (9.7% vs 11.1%) between the Dex group and control group (All P>0.05). Conclusion This retrospective study showed Dex infusion in elderly patients undergoing major joint replacement was associated with lower incidence of postoperative AKI, less opioid consumption, and shorter extubation time and hospital stay. However, the Dex group had higher incidence of bradycardia. We found no statistical differences in other perioperative adverse complications between the groups.
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Affiliation(s)
- He Zhu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Aolin Ren
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Kang Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Qiuchong Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Mengjun Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Jindong Liu
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
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Oh TK, Song IA, Choi Y. The Association Between Total Relative Value Unit and 90-Day Mortality After Noncardiac Surgery: A Hospital Data Registry Study. Surg Innov 2020; 27:461-467. [PMID: 32510279 DOI: 10.1177/1553350620923523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The total relative value unit (TRVU) of surgery reflects surgical complexity. However, its impact on mortality after noncardiac surgery has not been identified. This study aimed to investigate the association of TRVUs for surgery with postoperative 90-day mortality in adult patients who received planned, elective noncardiac surgery. We hypothesized that higher TRVU was associated with an increase in 90-day mortality after noncardiac surgery. Method. This retrospective cohort study analyzed medical records of adult patients admitted to a single tertiary academic hospital between January 2012 and December 2018 for planned elective noncardiac surgery. The primary end point was 90-day mortality. Results. A total of 112 606 patients were included. Among them, 561 patients (.5%) exhibited mortality within 90-days. In the multivariable model, an increase of 10 000 points of TRVUs was not significantly associated with 90-day mortality (odds ratio: .98, 95% confidence interval: .93 to 1.04; P = .536). Additionally, when it was divided into 4 quartile groups (Q1, Q2, Q3, and Q4), Q2, Q3, and Q4 group of TRVUs were not associated with 90-day mortality compared to the Q1 group of TRVUs (P = .058, .984, and .237, respectively). In receiver-operating characteristic analysis, the area under the curve of TRVUs for a 90-day mortality rate was .61. Conclusions. In conclusion, TRVUs were not associated significantly with a 90-day mortality rate after noncardiac surgery and have a low predictive ability for 90-day mortality after noncardiac surgery alone.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Korea
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Ma Y, Fang K, Gang S, Peng J, Jiang L, He F, Wang Z, Sun L, Zhu Y. Occurrence and predictive factors of acute renal injury following hip and knee arthroplasty. Clin Exp Nephrol 2020; 24:598-605. [PMID: 32201917 DOI: 10.1007/s10157-020-01874-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND To analyze the incidence of early acute kidney injury (AKI) and perioperative factors following hip and knee joint replacement. METHODS A total of 6281 patients from the department of orthopedics from January 2016 to July 2018 were enrolled, and 1490 patients undergoing hip and knee arthroplasty met the inclusion criteria. The preoperative, intraoperative and postoperative parameters were recorded. The retrospective cohort study was carried out to analyze predictors for AKI and postoperative creatinine elevation following hip and knee joint replacement. RESULTS Eighty patients (5.4%) met AKI criteria. Age, American Society of Anesthesiologists (ASA) physical status and preoperative diabetes were identified as independent predictors for postoperative AKI in patients undergoing hip and knee arthroplasty (p < 0.05). Age, male, preoperative diabetes, hypertension, and preoperative creatinine were identified as independent predictors for postoperative creatinine elevation (p < 0.05). Patients with AKI were more likely to enter the ICU than non-AKI patients (25% vs 5.6%, p < 0.05). Compared with non-AKI patients, the total hospital stay (16 [11-22] vs 13 [10-16] days) and postoperative hospital stay (11 [8-14] vs 8 [7-11] days) for AKI patients were significantly prolonged (p < 0.05). CONCLUSION The study shows age, male, preoperative diabetes, hypertension, and preoperative creatinine were independent predictors for postoperative creatinine elevation. In addition, age, ASA physical status and preoperative diabetes are independent predictors for postoperative AKI in patients undergoing hip and knee joint replacement. Postoperative AKI seems to increase ICU admission and significantly prolonged hospital stay.
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Affiliation(s)
- Yi Ma
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Kaiyun Fang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China.
| | - Shaopeng Gang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Jing Peng
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Ling Jiang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Fujuan He
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Zhenghua Wang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Li Sun
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, 55004, Guizhou, China
| | - Yan Zhu
- Department of Statistics, School of Public Health, University of Guizhou Medical University, Guiyang, 55002, Guizhou, China
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Aksoy N, Şelimen D. Investigation of the Causes and Risk Factors of Previous End-Stage Renal Disease in Kidney Transplant Recipients. Transplant Proc 2019; 52:140-145. [PMID: 31901330 DOI: 10.1016/j.transproceed.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a pathophysiological process with many etiologic causes, often leading to end-stage renal disease (ESRD). The distribution of the causes that lead to ESRD varies by country, race, and sex. Renal failure may be prevented by determining these differences and reducing the risk factors. OBJECTIVE The purpose of the study was to determine the causes and risk factors of previous ESRD in kidney transplant (KT) recipients. METHODS In this descriptive, cross-sectional study, 393 KT recipients fitting the study criteria gave written consent to participate. Data were collected in face-to-face interviews at the Transplant Center using survey forms prepared by the researchers. RESULTS According to a multivariate logistic regression analysis of the dependent variable of ESRD diagnosis age of KT recipients, the factors affecting ESRD diagnosis age were found to be job (Odds ratio (OD) = 5.76; 95% CI [2.291-14.481]), diabetes mellitus (DM) (OD = 2.94; 95% CI [1.143-7.571]), polycystic kidney disease (PKD) (OD = 4.55; 95% CI [1.737-11.919]), hypertension (HT) (OD = 3.53; 95% CI [2.132-5.854]), family history of ESRD (OD = 0.57; 95% CI [0.341-0.963]), surgical procedure history (OD = 1.93; 95% CI [1.150-3.230]), and stress level (OD = 5.86, 95% CI [2.212-15.528]). CONCLUSION It is important that we determine the changeable risk factors related to ESRD development in order to prepare strategies aimed at preventing ESRD, the frequency and prevalence of which is gradually increasing. Modifiable risk factors should be identified, particularly in KT recipients, to preserve the functions of the transplanted kidney.
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Affiliation(s)
- Nilgün Aksoy
- Akdeniz University, Faculty of Nursing, Antalya, Turkey.
| | - Deniz Şelimen
- School of Health Sciences, European University of Lefke, Lefke, TRNC
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Oh TK, Chung SH, Park J, Shin H, Chang CB, Kim TK, Do SH. Effects of Perioperative Magnesium Sulfate Administration on Postoperative Chronic Knee Pain in Patients Undergoing Total Knee Arthroplasty: A Retrospective Evaluation. J Clin Med 2019; 8:jcm8122231. [PMID: 31861187 PMCID: PMC6947579 DOI: 10.3390/jcm8122231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/07/2019] [Accepted: 12/16/2019] [Indexed: 01/24/2023] Open
Abstract
We aimed to investigate whether perioperative magnesium sulfate administration was associated with the incidence of chronic persistent postoperative pain (PPP) following total knee arthroplasty (TKA). This retrospective observational study was performed at a single tertiary academic hospital. We reviewed the medical records of adult patients who were admitted between August 2012 and July 2017. Patients who received magnesium sulfate during surgery were the magnesium group. The presence of PPP, one year after TKA, was evaluated using a binary logistic regression analysis. A total of 924 patients were included in the analysis, and 148 patients (16.0%) experienced PPP one year after TKA. In the multivariable model, the magnesium group had a 62% lower rate of PPP one year after TKA compared to the control group (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.16 to 0.90; p = 0.027). This finding was similar in the sensitivity analysis using propensity score adjustment (OR: 0.38, 95% CI: 0.16 to 0.93; p = 0.036). We showed that perioperative magnesium sulfate administration was associated with a lower rate of PPP one year after TKA. Our results suggest that magnesium sulfate administered perioperatively is effective for the alleviation of acute and chronic pain after surgery.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Seung Hyun Chung
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Jinwoo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Hyunjung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | | | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea
- Correspondence:
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