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Orfanos G, Nantha Kumar N, Redfern D, Burston B, Banerjee R, Thomas G. The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement. Bone Jt Open 2023; 4:899-905. [PMID: 37995746 PMCID: PMC10667041 DOI: 10.1302/2633-1462.411.bjo-2023-0137.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Aims We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI). Methods This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported. Results The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI. Conclusion The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.
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Affiliation(s)
- Georgios Orfanos
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Nakulan Nantha Kumar
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Keele University, Newcastle, UK
| | - Daniel Redfern
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Ben Burston
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Robin Banerjee
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Geraint Thomas
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Keele University, Newcastle, UK
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Post-operative complications of total knee arthroplasty in patients with hypertension. INTERNATIONAL ORTHOPAEDICS 2023; 47:701-709. [PMID: 36576519 DOI: 10.1007/s00264-022-05668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypertension is one of the most common comorbidities among patients undergoing surgery. However, few studies have focused on patients undergoing knee arthroplasty, and most of them had small sample sizes. This study aimed to analyze post-operative complications associated with hypertension in patients who underwent knee replacement surgery. METHODS Data from the 2019 National Inpatient Sample (NIS) database were used. Patients who underwent primary total knee arthroplasty (pTKA) and those who underwent aseptic revision total knee arthroplasty (rTKA) were analyzed separately. Propensity score matching was performed to reduce the effects of demographic factors and comorbidities other than hypertension on post-operative complications. A multinomial logistic regression that included all significantly different demographics and comorbidities was performed to verify the results and evaluate the odds ratios. RESULTS A total of 107,981 patients who underwent pTKA and 6571 who underwent rTKA owing to mechanical complications were identified in the 2019 NIS database. Compared with the non-hypertension group, patients with hypertension had a higher risk of developing acute renal failure and electrolyte disorders after TKA. Further analysis revealed that hyponatraemia and hypokalaemia were associated with hypertension. CONCLUSIONS Hypertension was associated with the incidence of acute renal failure after TKA. It is important to identify patients with risk factors for acute renal failure (in addition to hypertension) and take careful measures to prevent acute renal failure in them.
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Agar A, Gulabi D, Sahin A, Gunes O, Hancerli CO, Kılıc B, Erturk C. Acute kidney injury after hip fracture surgery in patients over 80 years of age. Arch Orthop Trauma Surg 2022; 142:2245-2252. [PMID: 34056678 DOI: 10.1007/s00402-021-03969-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study is to determine the rate of acute kidney injury (AKI) after hip fracture surgery over the age of 80 and to investigate the factors associated with AKI. METHODS From January 2015 to January 2020, 589 patients who underwent surgery of hip fractures at our institution were retrospectively reviewed. Serum creatinine (sCr) was analysed daily pre- and postoperatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on KDIGO (Kidney Disease Global Outcomes) criteria. The incidence, risk factors, and mortality of postoperative AKI were investigated. RESULTS Out of 589 patients, 58 developed an AKI (9.8%). Smoking (p: 0.004), pre and postoperative low albumin level (p < 0.05), pre- and postoperative high potassium level (p < 0.05), pre- and postoperative high urea levels (p < 0.05), high amount of intra-operative bleeding (p: 0.003) and prolonged surgery time (p: 0.003) were found to be risk factors associated with AKI. Although the mortality rate was higher in the AKI group, it was not statistically significant (p > 0.05). CONCLUSION AKI is a temporary but common complication following hip fracture surgery, which can also be predicted if risk factors are adequately observed. It typically increases the length of hospital stays, mortality and morbidity. LEVEL OF EVIDENCE Level III evidence, Retrospective comparative study.
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Affiliation(s)
- Anil Agar
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey.
| | - Deniz Gulabi
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Adem Sahin
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Orhan Gunes
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Cafer Ozgur Hancerli
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Bulent Kılıc
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Cemil Erturk
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
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Angerett NR, Yevtukh A, Ferguson CM, Kahan ME, Ali M, Hallock RH. Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty. J Arthroplasty 2022; 37:S1004-S1009. [PMID: 34952163 DOI: 10.1016/j.arth.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Perioperative hip and knee arthroplasty complications remain a significant clinical and financial burden. Our institution has shifted to developing protocols to decrease these perioperative complications. This study focuses on acute kidney injury (AKI) rate status post primary total joint arthroplasty (TJA). Current literature demonstrates a 2%-15% incidence of AKI following TJA. However, there is a paucity of published literature on protocols that have effectively reduced AKI rates following TJA. The purpose of this study is to evaluate the effect that our institutionally developed perioperative renal protocol had on the postoperative AKI rates. METHODS A retrospective cohort study was performed. Patient demographics, baseline creatinine, and postoperative creatinine values during the patient's hospitalization were collected and analyzed. The preintervention cohort data contained all patients at our institution who underwent a primary TJA from November 1, 2016 to January 1, 2018. The postintervention cohort included all primary TJA patients from July 1, 2018 to February 2, 2020. AKI was defined using the AKI Network classification system comparing baseline and postoperative creatinine values. A multivariate analysis was performed to determine the statistical significance of our results. RESULTS Before intervention 1013 patients underwent a primary TJA with 68 patients developing an AKI postoperatively. After intervention 2169 patients underwent primary TJA with 90 patients developing an AKI (6.71% vs 4.15%; P = .0015, odds ratio = 0.59, 95% confidence interval = 0.42-0.82). CONCLUSION This study demonstrated that implementation of a perioperative renal protocol can significantly reduce AKI rates. A reduction in AKI rates following TJA will result in improved outcomes and secondarily decrease the financial impact of postoperative complications seen following TJA.
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Affiliation(s)
- Nathan R Angerett
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Rubin Institute for Advanced Orthopedics, Center for Joint Preservation & Replacement, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD
| | | | | | - Michael E Kahan
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Rubin Institute for Advanced Orthopedics, Center for Joint Preservation & Replacement, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Muzaffar Ali
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA
| | - Richard H Hallock
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Orthopedic Institute of Pennsylvania, Camp Hill, PA
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Preventing Acute Kidney Injury and Hypotension After Elective Total Joint Arthroplasty Is Possible: An Update to an Established Multidisciplinary Protocol. J Am Acad Orthop Surg 2021; 29:e1303-e1312. [PMID: 34061804 DOI: 10.5435/jaaos-d-20-01352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/26/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Based on preoperative and perioperative risk factors that have been found to correlate with the development of acute kidney injury (AKI), our institution developed a protocol aimed at managing and improving outcomes in all elective THA and TKA patients. This article highlights the continued success and growth of our protocol aimed at decreasing AKI and hypotension in elective total joint arthroplasty patients. METHOD A multidisciplinary team comprising orthopaedic surgeons, nephrologists, anesthesiologists, cardiologists, and internal medicine hospitalists created a comprehensive protocol aimed at decreasing complications after elective joint arthroplasty and improving clinical outcomes across multiple hospitals. Patient demographics, hospital length of stay, readmission rates, mortality, and postoperative AKI and hypotension incidences were recorded and compared between preprotocol phase I (initial protocol implementation) and phase II (protocol expansion across 10 hospitals) patient cohorts. RESULTS Overall, 3,222 patients over 56 months and 10 hospitals were included. Our phase II AKI rate (0.6%) was significantly lower than our preprotocol rate (6.2%, P < 0.01) and statistically similar to our phase I rate (1.2%, P = 0.61). Our hypotension rate in phase II (6.8%) was significantly lower than our preprotocol rate (12.7%, P < 0.01) but statistically similar to our phase I rate (5.9%, P = 0.40). Furthermore, a significant decrease was observed in hospital length of stay (P < 0.01) over time, but no difference was observed in readmission (P = 0.59) and mortality rates (P = 1.00) over time. DISCUSSION This protocol-driven interventional study provides a detailed and successful multidisciplinary method to manage and decrease rates of AKI and hypotension in a large patient cohort across multiple hospital centers.
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Nikkinen O, Jämsä E, Aaltonen T, Alahuhta S, Ohtonen P, Vakkala M. Perioperative acute kidney injury and urine output in lower limb arthroplasties. Acta Anaesthesiol Scand 2021; 65:1054-1064. [PMID: 33866539 DOI: 10.1111/aas.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aimed to evaluate the occurrence and perioperative risk factors of acute kidney injury (AKI) in primary elective hip and knee and emergency hip arthroplasty patients. We also aimed to assess the effect of urine output (UOP) as a diagnostic criterion in addition to serum creatinine (sCr) levels. We hypothesized that emergency arthroplasties are prone to AKI and that UOP is an underrated marker of AKI. METHODS This retrospective, register-based study assessed 731 patients who underwent primary elective knee or hip arthroplasty and 170 patients who underwent emergency hip arthroplasty at Oulu University Hospital, Finland, between January 2016 and February 2017. RESULTS Of the elective patients, 18 (2.5%) developed AKI. The 1-year mortality rate was 1.5% in elective patients without AKI and 11.1% in those with AKI (P = .038). Of the emergency patients, 24 (14.1%) developed AKI. The mortality rate was 16.4% and 37.5% in emergency patients without and with AKI, respectively (P = .024). In an AKI subgroup analysis of the combined elective and emergency patients, the mortality rate was 31.3% (n = 5) in the sCr group (n = 16), 23.5% (n = 4) in the UOP group (n = 17), and 22.2% (n = 2) in AKI patients who met both the sCr and UOP criteria (n = 9). CONCLUSION Emergency hip arthroplasty is associated with an increased risk of AKI. Since AKI increases mortality in both elective and emergency arthroplasty, perioperative oliguria should also be considered as a diagnostic criterion for AKI. Focusing solely on sCr may overlook many cases of AKI.
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Affiliation(s)
- Okke Nikkinen
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine University of OuluOulu University Hospital Oulu Finland
| | - Elias Jämsä
- Faculty of Medicine University of Oulu Oulu Finland
| | | | | | - Pasi Ohtonen
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine University of OuluOulu University Hospital Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
- Department of Anaesthesiology Oulu University Hospital Oulu Finland
| | - Merja Vakkala
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine University of OuluOulu University Hospital Oulu Finland
- Department of Anaesthesiology Oulu University Hospital Oulu Finland
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Dagneaux L, Limberg AK, Osmon DR, Leung N, Berry DJ, Abdel MP. Renal Toxicity Associated With Resection and Spacer Insertion for Chronic Hip PJI. J Arthroplasty 2021; 36:3289-3293. [PMID: 33933331 DOI: 10.1016/j.arth.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Two-stage exchange arthroplasty with high-dose antibiotic-loaded bone cement spacer and intravenous (IV) antibiotics is the most common method of managing infected total hip arthroplasties. However, the contemporary incidence, risk factors, and outcomes of acute kidney injuries (AKIs) in this cohort are unknown. METHODS We identified 227 patients treated with 256 antibiotic-loaded bone cement spacers after resection of an infected primary total hip arthroplasty between 2000 and 2017. Mean age was 65 years, mean body mass index was 30 mg/kg2, 55% were men, and 16% had pre-existing chronic kidney disease (CKD). Spacers were in situ for a mean of 15 weeks, concomitantly associated with IV or oral antibiotics for a mean of 6 weeks. AKI was defined as a creatinine ≥1.5X baseline or ≥0.3 mg/dL. Mean follow-up was 8 years. RESULTS AKI occurred in 13 patients without pre-existing CKD (7%) vs 10 patients with CKD (28%; OR 5; P = .0001). None required acute dialysis. Postoperative fluid depletion (β = 0.31; P = .0001), ICU requirement (β = 0.40; P = .0001), and acute atrial fibrillation (β = 0.43; P = .0001) were independent predictors for AKI in patients without pre-existing CKD. Duration of in situ spacer, mean antibiotic dose in cement, use of amphotericin B, and type of IV antibiotics were not significant risk factors. At last follow-up, 8 AKIs progressed to CKD, with one receiving dialysis 7 years later. CONCLUSION AKIs occurred in 7% of patients with normal renal function, with 5-fold greater risk in those with CKD, and 4% did develop CKD. Importantly, causes of acute renal blood flow impairment were independent predictors for AKI. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Louis Dagneaux
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Douglas R Osmon
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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8
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Jämsä P, Reito A, Oksala N, Eskelinen A, Jämsen E. Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty? Bone Joint J 2021; 103-B:689-695. [PMID: 33789475 DOI: 10.1302/0301-620x.103b4.bjj-2020-0715.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. METHODS This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. RESULTS There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. CONCLUSION We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article: Bone Joint J 2021;103-B(4):689-695.
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Affiliation(s)
- Pyry Jämsä
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.,Cardiovascular Research Center, Tampere, Finland
| | | | - Esa Jämsen
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Wu XD, Liu JC, Li YJ, Wang JW, Qiu GX, Huang W. The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting. J Orthop Traumatol 2020; 21:19. [PMID: 33170383 PMCID: PMC7655881 DOI: 10.1186/s10195-020-00559-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
Background Recent studies suggest that routine postoperative laboratory tests are not necessary after primary elective total hip arthroplasty (THA). This study aims to evaluate the utility of routine postoperative laboratory tests in patients undergoing THA for hip fracture in a semi-urgent clinical setting. Materials and methods This retrospective study included 213 consecutive patients who underwent primary unilateral THA for hip fractures. Patient demographics, clinical information, and laboratory tests were obtained from the electronic medical record system. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory test-related interventions. Results A total of 207 patients (97.18%) had abnormal postoperative laboratory results, which were mainly due to anemia (190/213, 89.20%) and hypoalbuminemia (154/213, 72.30%). Overall, 54 patients (25.35%) underwent a clinical intervention, 18 patients received blood transfusion, and 42 patients received albumin supplementation. Factors associated with blood transfusion were long operative time and low preoperative hemoglobin levels. Factors associated with albumin supplementation were long operative time and low preoperative albumin levels. Of the 33 patients with abnormal postoperative creatinine levels, 7 patients underwent a clinical intervention. For electrolyte abnormalities, sodium supplementation was not given for hyponatremia, three patients received potassium supplementation, and one patient received calcium supplementation. Conclusions This study demonstrated a high incidence of abnormal postoperative laboratory tests and a significant clinical intervention rate in patients who underwent THA for hip fracture in a semi-urgent clinical setting, which indicates that routine laboratory tests after THA for hip fracture are still necessary for patients with certain risk factors. Level of Evidence Level III. Trial registration Clinical trial registry number ChiCTR1900020690.
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Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.,Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jia-Cheng Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Yu-Jian Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Jia-Wei Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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Yasin MS, Farah RI, Hammad Y, Isleem UN, Yaghi RT, Zughoul BM, Alobaidi MM, Alqudah MA. Determining the risk of acute kidney injury in patients who underwent total joint replacement: A retrospective study. J Orthop Sci 2020; 25:1029-1034. [PMID: 32014344 DOI: 10.1016/j.jos.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/23/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Total joint replacement (TJR) is a commonly performed procedure worldwide, and postoperative acute kidney injury (AKI) is one of the complications that determine the overall prognosis in various surgical settings. We aimed to identify the risk of AKI after TJR (primary and revision) and determine the factors associated with postoperative AKI. METHODS We performed a retrospective study of 1068 patients (>18 years) who underwent TJR between 2014 and 2019 at a tertiary medical center. Patients' demographic, clinical, and laboratory data were reviewed. RESULTS A total of 1068 patients were included in this study [mean age, 60.5 ± 13 years; 260 men (24.3%); 808 women (75.7%)]. A total of 962 patients (90.1%) underwent primary joint replacement (PJR) and 106 underwent joint revision (9.9%). Sixty-six patients (6.2%) had postoperative AKI. Primary total hip replacement patients had a lower risk of AKI than patients with other types of TJR (3.0%; p = 0.024). The factors associated with AKI (adjusting for known confounders) included male gender [adjusted odds ratio (AOR): 1.751; 95% confidence interval (CI): 1.01-3.03; p = 0.046], diabetes mellitus (DM) [AOR: 2.806; 95% CI: 1.687-5.023; p ≤ 0.001], hypertension (HTN) [AOR: 1.751; 95% CI: 1.159-3.442; p = 0.013], and the use of vancomycin as a prophylactic antibiotic [AOR: 1.691; 95% CI: 1.1-2.913; p = 0.050]. Chronic kidney disease (CKD) [AOR: 1.00; 95% CI: 0.432-2.27; p = 0.981] was not found to be a significant risk factor. CONCLUSION In this study, the risk of preoperative AKI in patients who underwent TJR was 6.2%. Male gender, preoperative comorbidities such as DM and HTN, and preoperative use of vancomycin were associated with increased risk of postoperative AKI.
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Affiliation(s)
- Mohamad Samih Yasin
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Randa I Farah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Yazan Hammad
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Ula Nael Isleem
- School of Medicine, The University of Jordan, Amman, Jordan.
| | - Rami Tayseer Yaghi
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Basheer Mohammed Zughoul
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Mustafa Mohammed Alobaidi
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Mohammad Ali Alqudah
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
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Takeshita S, Sonohata M, Kitajima M, Kawano S, Eto S, Mawatari M. Acute Deterioration of Kidney Function after Total Hip Arthroplasty. Malays Orthop J 2020; 14:111-119. [PMID: 32983385 PMCID: PMC7513646 DOI: 10.5704/moj.2007.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Post-operative acute kidney injury is a serious complication and identifying modifiable factors could assist in peri-operative management. This study aimed to identify the pre-operative and intra-operative factors associated with the incidence of post-operative acute kidney injury and acute deterioration of kidney function after total hip arthroplasty. Materials and methods: This single-center, retrospective, observational study included 203 patients who underwent unilateral primary total hip arthroplasty. Acute kidney injury was determined using biochemical markers according to the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria. Acute deterioration of kidney function was defined as the reduction of estimated glomerular filtration rate by ≥10ml/min/1.73m2. Results: Prior to total hip arthroplasty, 20% of all patients met the chronic renal dysfunction criterion of glomerular filtration rates <60ml/min/1.73m2 (glomerular filtration rate categories G3a-G5). Incidence rates of acute kidney injury and acute deterioration of kidney function after total hip arthroplasty were 0.49% and 6.9%, respectively. Multivariate regression analysis showed that diabetes mellitus and use of nonsteroidal anti-inflammatory drugs before total hip arthroplasty were significant risk factors for acute deterioration of kidney function. Advanced age, preoperative renal dysfunction, antihypertensive, diuretics, or statin use, operation time, total blood loss, type of anesthetic, and body mass index were not significant risk factors. Conclusion: Diabetes mellitus and use of nonsteroidal anti-inflammatory drugs were controllable risks, and multidisciplinary approaches are a reasonable means of minimising peri-operative acute kidney injury or acute deterioration of kidney function.
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Affiliation(s)
- S Takeshita
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - M Sonohata
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - M Kitajima
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - S Kawano
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - S Eto
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - M Mawatari
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
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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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Contreras K, Rodriguez D, Bernal-Gutiérrez M, Villamizar JP, Baquero-Galvis R, Arguello-Morales O, Montoya-Cárdenas C, Buitrago G. Incidence of chronic kidney disease in patients undergoing arthroplasty: A systematic review of the literature. Orthop Rev (Pavia) 2019; 11:8157. [PMID: 31897277 PMCID: PMC6912148 DOI: 10.4081/or.2019.8157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022] Open
Abstract
Patients undergoing arthroplasty are exposed to different interventions that can lead to renal dysfunction. There is abundant evidence of the incidence and factors associated with acute kidney injury (AKI); however, the incidence and the factors associated with chronic kidney disease (CKD) are not clear. The objective of this study is to determine the incidence and associated factors in arthroplasty patients. A systematic review of the literature was carried out following the recommendations of PRISMA and the Cochrane Collaboration (PROSPERO Protocol CRD42018075929). The search was carried out in Medline, Embase, Cochrane and LILACS. No language or date limits were set. Observational studies were included: cases and controls, and cohorts. The revision of titles and abstracts and the reading of the full texts was performed in a paired manner. The quality of the evidence was evaluated with the Newcastle-Ottawa tool. The initial search found 1279 titles and abstracts. We excluded 115 duplicates, and 1153 in the reading of titles and abstracts. Three articles met the inclusion criteria and were of acceptable quality. The incidence of severe CKD after hip or knee arthroplasty was 1.2% at 1 year up to 6.5% at 9 years. The evidence of the incidence and risk factors associated with CKD in patients undergoing arthroplasty is very scarce and heterogeneous. Further primary studies are required in order to have more valid and trustable results.
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Affiliation(s)
- Kateir Contreras
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C
- Hospital Universitario Nacional de Colombia, Bogotá D.C
| | - Dayany Rodriguez
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Marcela Bernal-Gutiérrez
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Juan Pedro Villamizar
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Romar Baquero-Galvis
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Oscar Arguello-Morales
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Carlos Montoya-Cárdenas
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Giancarlo Buitrago
- Hospital Universitario Nacional de Colombia, Bogotá D.C
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
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Rantalaiho I, Gunn J, Kukkonen J, Kaipia A. Acute kidney injury following hip fracture. Injury 2019; 50:2268-2271. [PMID: 31623901 DOI: 10.1016/j.injury.2019.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture causes disability and excess mortality in the aging population. Acute kidney injury (AKI), is known to diminish survival of critically ill and trauma patients. AKI is also a common perioperative complication among surgical patients. We examined the effect of AKI on the survival of hip fracture patients in a Finnish hip fracture population and the risk factors for AKI in a prospective study. METHODS The study cohort constituted of 486 consecutive low-energy trauma hip fracture patients referred to Satakunta Central Hospital (Pori, Finland) and Turku University Hospital (Turku, Finland). The patients underwent standard diagnostics and treatment in the emergency department (ER) and were operated according to the local treatment protocol. Serum creatinine (sCr) was analyzed daily pre- and post-operatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS The incidence of AKI in the study cohort was 8.4% (40/475). Eleven patients were excluded due to missing sCr data. The baseline characteristics of AKI and non-AKI groups differed significantly concerning baseline sCr but were otherwise similar. At 90-day follow-up, the overall mortality was 14.4%. Patients with AKI had a significantly higher mortality (35.0%) than those with no AKI (12.7%) (p < 0.001). Dementia, preoperative sCr and any stage of AKI were independent predictors for mortality. Dementia and preoperative sCr were independently associated with post-operative AKI. CONCLUSION In this study AKI was a significant factor associated with a 3 -fold mortality during the first three months after surgery for low-energy trauma hip fracture.
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Affiliation(s)
- Ida Rantalaiho
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, P.O. Box 28, FIN-20701, Turku, Finland.
| | - Jarmo Gunn
- Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Juha Kukkonen
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Satakunta Central Hospital, Pori, Finland
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland
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15
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Weiner SM. [Treatment of rheumatic disease with renal insufficiency]. DER ORTHOPADE 2019; 48:927-935. [PMID: 31531703 DOI: 10.1007/s00132-019-03807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reduced renal function is not rare in patients with inflammatory rheumatic diseases and is associated with an increased risk of treatment-induced and perioperative adverse events. METHOD A literature search was carried out for the medical treatment and perioperative management of rheumatic disease in the presence of renal insufficiency. RESULTS Patients with rheumatic disease and renal insufficiency have a higher risk of cardiovascular disease, bone loss and immunodeficiency than those without kidney disease. The perioperative rate of cardiovascular and infectious complications and the risk of acute kidney failure are elevated in these patients. The pharmacokinetics of many drugs used in rheumatology is influenced by the kidney function. Especially methotrexate is contraindicated in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. Nonsteroidal anti-inflammatory drugs (NSAIDS) and cyclooxygenase (COX)-2 inhibitors should not be used with renal insufficiency or only for a short term with the lowest effective dose. The treatment of osteoporosis with antiresorptive drugs may lead to adynamic bone disease in advanced kidney disease, and, therefore, the use of these drugs is controversial. CONCLUSION Medication should be modified in patients with rheumatic disease and kidney involvement according the grade of renal insufficiency. There is also a need for special perioperative management in these patients, with interdisciplinary cooperation of rheumatologists, nephrologists and orthopedic doctors.
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Affiliation(s)
- S M Weiner
- 2. Medizinische Abteilung, Rheumatologie, Immunologie, Diabetologie, Endokrinologie, Hochdruckkrankheiten, Zentrum für Dialyse und Nephrologie, Krankenhaus der Barmherzigen Brüder und KfH-Nierenzentrum Nordallee, Nordallee 1, 54292, Trier, Deutschland.
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Nikkinen O, Nieminen T, Alahuhta S, Ohtonen P, Vakkala M. Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age. Acta Anaesthesiol Scand 2019; 63:859-870. [PMID: 30888058 DOI: 10.1111/aas.13352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/10/2019] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the prevalence of chronic kidney disease (CKD) and the incidence of perioperative acute kidney injury (AKI) in primary arthroplasty patients over 65 years of age. Risk factors, perioperative events and the outcome of surgery were evaluated. METHODS This retrospective, hospital register-based study consists of patients operated in 2014 in the area of Oulu, Finland. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. The incidence of AKI was evaluated based on the serum creatinine criteria of the KDIGO (Kidney Disease, Improving Global Outcomes) classification. RESULTS Of the 807 patients, 60.8% had mildly decreased (60-89 ml/min/1.73 m2 ) and 13.5% moderately to severely decreased eGFR (<60 ml/min/1.73 m2 ) preoperatively. Only 33.9% of patients with an eGFR < 60 ml/min/1.73 m2 had a diagnosis of a kidney disease. In emergencies, 46.9% of patients with an eGFR < 60 ml/min/1.73 m2 were deceased at the 12-month follow-up point. The measurement of postoperative sCr was not complete (477/807) and was allocated to emergencies and older patient with more comorbidities. Of those whose postoperative sCr was available, 14 (2.9%) fulfilled AKI criteria. Most of the AKI cases had a decrease in eGFR preoperatively, a diagnosed kidney disease or diabetes mellitus. CONCLUSIONS Impairment of kidney function was common and was related to mortality in emergency arthroplasties. Measurements of postoperative sCr were allocated to high risk patients. Preoperative kidney function, kidney disease and diabetes mellitus were important determinants for perioperative AKI.
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Affiliation(s)
| | | | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu Oulu University Hospital Oulu Finland
| | - Pasi Ohtonen
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - Merja Vakkala
- Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu Oulu University Hospital Oulu Finland
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Acute Kidney Injury in Subjects With Chronic Kidney Disease Undergoing Total Joint Arthroplasty. Am J Med Sci 2019; 358:45-50. [PMID: 31079840 DOI: 10.1016/j.amjms.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/14/2019] [Accepted: 04/03/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) has been associated with higher incidence of complications after total joint arthroplasty (TJA) but the incidence, risk factors and outcomes of acute kidney injury (AKI) in this setting remains insufficiently understood. METHODS We assessed the impact of baseline CKD on the risk of developing AKI after TJA performed between 1/2012 and 12/2016 in a single-center, retrospective cohort study. CKD was defined by estimated glomerular filtration rate <60 mL/min/1.73 m2 on 2 separate occasions within 3 months prior TJA. AKI was defined using a modified Kidney Disease: Improving Global Outcomes criteria based on serum creatinine (sCr) only to assess the severity of AKI. Complete AKI recovery was defined as the lowest post-AKI sCr within 20% of pre-AKI sCr values and partial recovery if within 30%, all within 90 days after TJA. RESULTS Twenty-four percent of the 1,212 subjects undergoing TJA had pre-existing CKD. The overall incidence of AKI in the CKD subjects was 30%; of these, 55% had stage-1 AKI, 1% had stage-2 AKI and 44% had stage-3 AKI. AKI was more common in African Americans, those with diabetes or heart failure, requiring perioperative transfusions or receiving diuretics before surgery. While 82% of the AKI subjects achieved complete recovery of kidney function, 4% had only partial recovery and 14% did not reach a post-AKI sCr level within 30% of pre-AKI values. The incidence (P < 0.001) but not the severity (P = 0.202) of AKI correlated with stages of baseline CKD. CONCLUSIONS The presence of CKD was associated with a high incidence of AKI after TJA. In these subjects, more than half the cases of AKI were of mild degree and had a favorable outcome. However, 18% of them did not have complete recovery of kidney function. Stages of baseline CKD were associated with increased incidence but not severity of AKI after TJA.
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19
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Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8010066. [PMID: 30634487 PMCID: PMC6352044 DOI: 10.3390/jcm8010066] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The number of total hip arthroplasties (THA) performed across the world is growing rapidly. We performed this meta-analysis to evaluate the incidence of acute kidney injury (AKI) in patients undergoing THA. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until July 2018 to identify studies assessing the incidence of AKI (using standard AKI definitions of RIFLE, AKIN, and KDIGO classifications) in patients undergoing THA. We applied a random-effects model to estimate the incidence of AKI. The protocol for this meta-analysis is registered with PROSPERO (no. CRD42018101928). Results: Seventeen cohort studies with a total of 24,158 patients undergoing THA were enrolled. Overall, the pooled estimated incidence rates of AKI and severe AKI requiring dialysis following THA were 6.3% (95% CI: 3.8%–10.2%) and 0.5% (95% CI: 0.1%–2.3%). Subgroup analysis based on the countries by continent was performed and demonstrated the pooled estimated incidence of AKI following THA of 9.2% (95% CI: 5.6%–14.8%) in Asia, 8.1% (95% CI: 4.9%–13.2%) in Australia, 7.4% (95% CI: 3.2%–16.3%) in Europe, and 2.8% (95% CI: 1.2%–17.0%) in North America. Meta-regression of all included studies showed significant negative correlation between incidence of AKI following THA and study year (slope = −0.37, p <0.001). There was no publication bias as assessed by the funnel plot and Egger’s regression asymmetry test with p = 0.13 for the incidence of AKI in patients undergoing THA. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring dialysis in patients undergoing THA are 6.3% and 0.5%, respectively. There has been potential improvement in AKI incidence for patients undergoing THA over time.
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Yadav A, Alijanipour P, Ackerman CT, Karanth S, Hozack WJ, Filippone EJ. Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty. J Arthroplasty 2018; 33:3297-3303. [PMID: 30006109 DOI: 10.1016/j.arth.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/12/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) can complicate primary total joint arthroplasty (TJA) of the hip and knee, although the incidence of AKI following revision TJA including prosthetic joint infection (PJI) is poorly defined. We assessed the incidence and risk factors for AKI following revision TJA including surgical treatment of PJI with placement of an antibiotic-loaded cement (ALC) spacer. METHODS We retrospectively reviewed 3218 consecutive failed TJAs. Patients with aseptic failure were compared to those with PJI. AKI was determined by RIFLE creatinine criteria. PJIs treated with placement of ALC were compared to PJIs without. Risk factors for AKI were determined by multivariable analysis within the whole group and within those with PJI. RESULTS AKI developed in 3.4% of 2147 patients revised for aseptic reasons and in 45% of 281 with PJI, including 29% of 197 receiving an ALC and 82% of 84 patients treated with other procedures. By multivariable analysis, age, surgery for PJI, total number of surgeries, and estimated GFR 60-90 compared to >90 cc/min/1.73 m2 were significantly associated with AKI in the whole cohort. Among PJI patients, age, Charlson comorbidity index, and reimplantation surgery were associated with AKI by multivariable analysis. No differences were found between patients with PJI treated with or without ALC. No modifiable factors were found. CONCLUSION AKI develops following aseptic revision TJA at a rate similar to primary TJA, but at a significantly higher rate following surgery for PJI with or without placement of ALC.
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Affiliation(s)
- Anju Yadav
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pouya Alijanipour
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin T Ackerman
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Siddharth Karanth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal medicine, University of Texas Health Science, Center at Houston McGovern Medical School, Houston, Texas
| | - William J Hozack
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Tucker A, Hegarty P, Magill PJ, Blaney J, Armstrong LV, McCaffrey JE, Beverland DE. Acute Kidney Injury After Prophylactic Cefuroxime and Gentamicin in Patients Undergoing Primary Hip and Knee Arthroplasty-A Propensity Score-Matched Study. J Arthroplasty 2018; 33:3009-3015. [PMID: 29807788 DOI: 10.1016/j.arth.2018.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Perioperative acute kidney injury (AKI) can be associated with lower limb arthroplasty and increases morbidity, length of stay, and mortality. AKI is more prevalent in some antibiotic regimes compared with others. The aim of the present study is to assess the impact of cefuroxime (CEF), with or without gentamicin (±G), on AKI rates. METHODS A prospective cohort study involving patients undergoing hip or knee arthroplasty was performed, between September 1, 2015 and November 30, 2016. Prophylactic intravenous antibiotics were administered according to local policy. AKI was graded according to the validated Acute Kidney Injury Network criteria based on the changes from baseline serum creatinine values. Propensity score matching was performed to identify risk factors. The local audit department approved the study. Appropriate statistical analyses were performed. RESULTS A total of 2560 met the inclusion criteria, with a female preponderance (1447/2560; 56.5%). The mean age was 67.5 ± 10.7 years, with males being significantly younger (65.9 ± 10.9 vs 68.7 ± 10.4 years). AKI developed in 32 cases (1.25%). There was no difference in AKI rates between CEF alone and CEF in combination with gentamicin (1.07% vs 1.36%; P = .524). Overall 31/32 cases were Acute Kidney Injury Network stage I. AKI did not affect the length of stay. Postoperative infection rate was 7/2560 (0.27%). There were no incidences of Clostridium difficile-associated diarrhea. Multivariate analysis demonstrated an increased AKI risk with the use of intravenous gentamicin. CONCLUSION C ± G yields low rates of infection and AKI compared with high-dose penicillin-based regimes. It is a safe and effective choice for lower limb arthroplasty.
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Affiliation(s)
- Adam Tucker
- Outcomes Department, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Paul Hegarty
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Paul J Magill
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Janine Blaney
- Outcomes Department, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Lynne V Armstrong
- Department of Orthopaedics, Withers Ward 1A, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - John E McCaffrey
- Department of Anaesthetics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - David E Beverland
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
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22
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Kildow BJ, Karas V, Howell E, Green CL, Baumgartner WT, Penrose CT, Bolognesi MP, Seyler TM. The Utility of Basic Metabolic Panel Tests After Total Joint Arthroplasty. J Arthroplasty 2018; 33:2752-2758. [PMID: 29858101 DOI: 10.1016/j.arth.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/04/2018] [Accepted: 05/02/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Routine laboratory studies are often obtained daily after total joint arthroplasty (TJA) regardless of medical management. The purpose of this study was to investigate the utility of routine basic metabolic panel (BMP) tests after TJA. Furthermore, the goal was to identify factors that may predispose patients to abnormal laboratory values that require medical intervention. METHODS A retrospective review was performed on 767 patients who underwent primary TJA at a single institution. Preoperative and postoperative potassium, sodium, creatinine, and glucose values were collected along with demographic data, comorbidities, and procedural characteristics. Multivariable logistic regression models were used to determine independent risk factors for abnormal postoperative laboratory values. RESULTS Diabetes was associated with abnormal glucose (odds ratio [OR] 23.4, 95% confidence interval [CI] 10.7-51.0, P < .001), while chronic kidney disease was associated with abnormal creatinine (OR 3.1, 95% CI 1.7-5.8, P < .001) and potassium (OR 1.8, 95% CI 1.1-2.8, P = .014) requiring medical intervention. An abnormal preoperative laboratory value was also associated with medical treatment for each of sodium, potassium, and creatinine (all P < .001). Average number of BMP tests collected for patients who did not receive medical intervention was 2.8. This equated to $472,372.56 in total hospital charges. CONCLUSION Cost containment while maintaining high-quality patient care is critical. Routine postoperative BMP tests in patients with normal preoperative values without major medical comorbidities do not contribute to actionable information. Patients with diabetes, chronic kidney disease, or with abnormal preoperative values should obtain a BMP after TJA.
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Affiliation(s)
- Beau J Kildow
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vasili Karas
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth Howell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Cynthia L Green
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William T Baumgartner
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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The Incidence and Risk Factors of Acute Kidney Disease after Total Knee Arthroplasty with Early Postoperative Volume Supplement. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8718545. [PMID: 30105257 PMCID: PMC6076950 DOI: 10.1155/2018/8718545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/11/2018] [Accepted: 07/08/2018] [Indexed: 01/12/2023]
Abstract
Background Etiology of acute kidney disease (AKD) after total knee arthroplasty (TKA) was considered as multifactorial. However, the role of early postoperative volume supplement in AKD rate has not been investigated. The purpose of this study was to evaluate the incidence and risk factors of AKD in patients with early volume supplement following TKA. Methods This was a retrospective study with 458 patients who underwent unilateral TKA. All the patients received 6% tetrastarch, 7.5ml/kg, early in the postoperative period. Postoperative AKD was defined as the postoperative creatinine level ≥ 1.5 times compared with preoperative data. Potential variables associated with AKD were analyzed by multivariate logistic regression model to identify the AKD risk factors in TKA patients after early postoperative volume supplement. Results The AKD rate was 3.3% (15 patients) in all patients. Age (OR = 1.09; P = .031) and coronary artery disease (CAD) (OR = 3.63; P = .034) were associated with increased risk of development of postoperative AKD. Other comorbidities as hypertension, diabetes, and CKD were not statistically significant risk factors. Conclusion Our study demonstrated that age and CAD were independent risk factors of AKD in TKA patients. However, the common risk factors as hypertension, diabetes, and CKD were not significantly associated with AKD after TKA if early postoperative supplement of tetrastarch is administered.
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Abar O, Toossi N, Johanson N. Cost and determinants of acute kidney injury after elective primary total joint arthroplasty. Arthroplast Today 2018; 4:335-339. [PMID: 30186917 PMCID: PMC6123230 DOI: 10.1016/j.artd.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/07/2023] Open
Abstract
Background Acute kidney injury (AKI) is a serious complication after major surgery, which may lead to increased morbidity and mortality. The aim of this study was to identify cost and determinants of AKI after total joint arthroplasty. Methods A retrospective case-controlled study was conducted with 1719 primary elective total hip or knee replacements performed from January 2004 through September 2015 at an urban teaching hospital. Patients who developed AKI were matched in a 1:3 ratio with those in a control group who did not develop AKI based on age, sex, race, operated joint, and comorbidities including hypertension and diabetes. Increased postoperative serum creatinine was considered indicative of AKI. Results Fifty-four patients (3.1%) had AKI that was significantly associated with increased length of hospital stay (8.07 days) compared with that of the control group (4.50 days, P < .0001) and incurred significantly higher hospital charges ($224,533) than those of the control group ($142,753, P < .0001). We identified high body mass index, undergoing bilateral surgery in one session, high estimated blood loss, and longer duration of surgery as significant risk factors for AKI in univariate analysis. Elevated preoperative creatinine, large postoperative drop in hemoglobin, and high American Society of Anesthesiologists physical status scores were significant independent predictors of AKI in multivariate analysis. Conclusions Health-care providers and patients should work together to manage risk factors and to lower the risk of morbidity and mortality, longer in-hospital stay, and high associated costs of AKI.
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Affiliation(s)
- Orchideh Abar
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Nader Toossi
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Norman Johanson
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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Reducing Hypotension and Acute Kidney Injury in the Elective Total Joint Arthroplasty Population: A Multi-Disciplinary Approach. J Arthroplasty 2018. [PMID: 29526330 DOI: 10.1016/j.arth.2018.01.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND When critically analyzing our hospital system's rate of hypotension and acute kidney injury (AKI) after total joint arthroplasty, our incidence rates (14.54%, 6.02%) were much higher than our peers (7.17%, 2.03%) and national rates (2.0%, 3.3%). We present a multi-disciplinary management intervention that aimed to decrease overall complication rates. METHOD A multi-disciplinary team implemented a protocol at our suburban hospital to limit complication rates after joint replacement surgery. Hypotension, AKI, length of stay (LOS), re-admission rates, and mortality rates were compared before the protocol was implemented, after protocol implementation, and after protocol integration into our EMR (electronic medical record). RESULTS In total, 1233 patients over 36 months were followed. Hypotension rates after protocol implementation into EMR (group 3) were significantly lower than rates before the protocol (group 1) (P = .002), with rates after protocol implementation without EMR (group 2) trending toward a significant decrease from group 1 (P = .064). AKI rates in group 3 were significantly lower than group 1 (P = .000) and group 2 (P = .006). No difference was seen in hypotension rates between group 2 and 3 (P = .792) or AKI rates between group 1 and 2 (P = .533). Finally, no significant difference was seen between groups in LOS (P = .560), re-admission rates (P = .378), and mortality rates (all 0.0%). CONCLUSION By implementing a comprehensive electronic protocol consisting of pre-operative risk stratification, multi-disciplinary medical optimization, and an evolving post-operative management plan, significant decreases in hypotension and AKI can be seen.
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Jämsä P, Jämsen E, Huhtala H, Eskelinen A, Oksala N. Moderate to Severe Renal Insufficiency Is Associated With High Mortality After Hip and Knee Replacement. Clin Orthop Relat Res 2018; 476:1284-1292. [PMID: 29601379 PMCID: PMC6263598 DOI: 10.1007/s11999.0000000000000256] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients having elective hip or knee replacements, many comorbid conditions, including diabetes, cardiovascular disease, and congestive heart failure, are associated with postoperative mortality. Renal failure and a history of renal transplantation also increase mortality. However, the effect of different stages of chronic kidney disease on patients' prognoses is unclear. QUESTIONS/PURPOSES (1) What is the risk of postoperative mortality in different stages of chronic kidney disease after elective hip or knee replacement and does the risk increase with mild renal insufficiency? (2) How severe is the risk of death in patients with chronic kidney disease compared with other major medical comorbidities such as diabetes, cardiovascular disease, and congestive heart failure? (3) Are there risk factor combinations associated with especially poor survival? METHODS Using longitudinally maintained databases, the records of 18,575 patients (median age 69 years, 63% female, median body mass index 29 kg/m) undergoing elective hip and knee replacements from a single center between 2002 and 2011 were analyzed in this retrospective study. A total of 6519 (35%) patients had Stage I, 9917 (53%) Stage II, 2023 (11%) Stage III, 81 (0.4%) Stage IV, and 35 (0.2%) Stage V chronic kidney disease. Kaplan-Meier analysis was used to analyze mortality at different stages of the disease. Cox regression analysis was performed to compare the risk of death associated with the comorbid conditions of interest. Comorbid conditions with greatest risk for death (diabetes, coronary artery disease, and congestive heart failure) were combined separately with chronic kidney disease using logistic regression. According to data from the Finnish Population Register Centre, a total of 4055 deaths occurred in our patient cohort during the followup period. The median followup was 7.8 years (range, 0-14 years; interquartile range, 5.8-10.0 years). RESULTS The mean survival time was 13 years (95% confidence interval [CI], 12.5-12.7 years) in Stage I, 11 years (95% CI, 11.3-11.5 years) in Stage II, 9 years (95% CI, 9.2-9.7 years) in Stage III, 7 years (95% CI, 5.6-7.5 years) in Stage IV, and 6 years (95% CI, 4.9-8.0 years) in Stage V (p < 0.001). Compared with Stage I chronic kidney disease, the risk of death increased with every step of the disease (adjusted hazard ratio [HR], 1.9 [95% CI, 1.76-2.10]; HR, 3.8 [95% CI, 3.39-4.19]; and HR, 8.1 [95% CI, 6.33-10.31] in Stages II, III, and IV-V, respectively). Compared with congestive heart failure (HR, 2.11 [95% CI, 1.81-2.45], p < 0.001), coronary disease (HR, 1.54 [95% CI, 1.40-1.69], p < 0.001), diabetes (HR, 1.71 [95% CI, 1.54-1.90], p < 0.001), and hypertension (HR, 1.35 [95% CI, 1.26-1.45], p < 0.001), Stage III and Stage IV to V chronic kidney disease are associated with poorer survival. The combination of chronic kidney disease and diabetes (odds ratio [OR], 8.15 [95% CI, 4.9-13.51]) had a synergistic effect on the risk of death compared with chronic kidney disease (OR, 2.36 [95% CI, 1.70-3.28]) or diabetes alone (OR, 1.19 [95% CI, 0.70-2.03]) during the first postoperative year. CONCLUSIONS All stages of chronic kidney disease have a harmful effect on long-term life expectancy in joint replacement recipients. The risk becomes clinically meaningful in the most severe forms of the disease, but also in moderate chronic kidney disease when it is accompanied by diabetes, coronary disease, or congestive heart failure. It should be recognized that these patients achieve fewer quality-adjusted life-years even if clinical outcomes were similar. The effect of chronic kidney disease on cost-effectiveness of hip and knee replacements should be investigated in future studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Pyry Jämsä
- P. Jämsä, E. Jämsen, N. Oksala, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland H. Huhtala, Faculty of Social Sciences, University of Tampere, Tampere, Finland A. Eskelinen, Coxa Hospital for Joint Replacement, Tampere, Finland N. Oksala, Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
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Jämsä PP, Oksala NKJ, Eskelinen AP, Jämsen ER. Chronic Kidney Diseases Among Patients Undergoing Elective Arthroplasty: Risk Groups and the Value of Serum Creatinine. J Arthroplasty 2018; 33:230-234.e1. [PMID: 28887023 DOI: 10.1016/j.arth.2017.07.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/10/2017] [Accepted: 07/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m2) in different patient groups and investigated whether CKD is missed by evaluation based on SCr. METHODS Preoperative SCr values were used to calculate eGFR in 20,575 consecutive hip or knee arthroplasties. RESULTS Prevalence of CKD was 9%-12%. It was higher among older women, knee arthroplasty patients, and patients with hypertension, diabetes, or coronary disease. Using SCr instead of eGFR leads to missing CKD in up to 7% of the cases. In older women and older patients with body mass index <25 kg/m2, half of CKD cases were missed. CONCLUSION Use of eGFR instead of SCr to detect CKD more accurately is recommended.
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Affiliation(s)
- Pyry P Jämsä
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Niku K J Oksala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Esa R Jämsen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Gharaibeh KA, Hamadah AM, Sierra RJ, Leung N, Kremers WK, El-Zoghby ZM. The Rate of Acute Kidney Injury After Total Hip Arthroplasty Is Low but Increases Significantly in Patients with Specific Comorbidities. J Bone Joint Surg Am 2017; 99:1819-1826. [PMID: 29088036 DOI: 10.2106/jbjs.16.01027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the rate and risk factors associated with the development of acute kidney injury after total hip arthroplasty, including the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS We retrospectively collected the demographic and comorbidity data of all patients who underwent total hip arthroplasty between 2004 and 2014 at our institution (n = 8,949). We conducted analyses of the entire cohort and a nested case-control subset. Subjects who developed acute kidney injury were matched by age, sex, and year of surgical procedure to subjects without acute kidney injury. Variables associated with acute kidney injury were determined using univariate and multivariate logistic regressions. RESULTS The mean patient age (and standard deviation) was 64.6 ± 13.8 years, 48.6% of patients were male, and 114 cases (1.1%) developed acute kidney injury, mostly stage 1 (79%). Variables associated with acute kidney injury included older age (odds ratio [OR], 1.4 per decade; p < 0.001), male sex (OR, 1.78; p = 0.005), chronic kidney disease (OR, 4.6; p < 0.001), heart failure (OR, 4.5; p < 0.001), diabetes (OR, 2.1; p < 0.001), and hypertension (OR, 2.1; p = 0.007). The results were consistent in the case-control analysis. NSAIDs were not associated with acute kidney injury (OR, 1.26; p = 0.36), but were avoided in subjects at risk, making any interpretation difficult because of confounding. A risk model for acute kidney injury after total hip arthroplasty was developed for clinical use and had good discrimination (area under the curve, 0.82; p < 0.001). CONCLUSIONS The rate of acute kidney injury after total hip arthroplasty is low, but increases significantly, from <1% to >20%, in those with several independent risk factors present preoperatively. Increasing awareness of these risk factors may help to decrease the risk of acute kidney injury after total hip arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kamel A Gharaibeh
- 1Division of Nephrology and Hypertension, Department of Internal Medicine (K.A.G., A.M.H., N.L., and Z.M.El-Z.), and Departments of Orthopedic Surgery (R.J.S.) and Biomedical Statistics and Informatics (W.K.K.), Mayo Clinic, Rochester, Minnesota
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Jiang EX, Gogineni HC, Mayerson JL, Glassman AH, Magnussen RA, Scharschmidt TJ. Acute Kidney Disease After Total Hip and Knee Arthroplasty: Incidence and Associated Factors. J Arthroplasty 2017; 32:2381-2385. [PMID: 28392132 DOI: 10.1016/j.arth.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The development of acute kidney disease (AKD) following total joint arthroplasty has not been well characterized in the literature. We sought to calculate the incidence and identify risk factors associated with postoperative AKD for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS A total of 1000 consecutive cases (860 unique patients, including revisions) of TKA or THA performed between January 2010 and May 2016 were identified. Seventy-nine cases were excluded due to pre-existing kidney dysfunction and 23 additional cases were excluded due to incomplete data, resulting in 898 cases included in the study. There were 492 females and 406 males with a mean age of 58.1 years (range, 14-93 years). The Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria and serum creatinine values were used to determine AKD status. Multiple logistic regression modeling was used to identify postoperative AKD risk factors. RESULTS Overall incidence of postoperative AKD was 6.8% (n = 61). Use of perioperative angiotensin receptor blocker (ARBs) or angiotensin-converting enzyme inhibitors (ACEi) (odds ratio [OR] = 2.09; P = .030), increasing body mass index (BMI) (OR = 1.58 per 10 kg/m2; P = .014), and use of vancomycin perioperatively (OR = 1.91; P = .021) were associated with increased odds of development of postoperative AKD. CONCLUSION A 6.8% incidence rate of postoperative AKD was noted in patients undergoing TKA or THA. Perioperative use of ARBs/ACEi, perioperative vancomycin use, and increased BMI were associated with increased odds of postoperative AKD.
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Affiliation(s)
- Eric X Jiang
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Hrishikesh C Gogineni
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joel L Mayerson
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Andrew H Glassman
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Thomas J Scharschmidt
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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Jämsä P, Jämsen E, Lyytikäinen LP, Kalliovalkama J, Eskelinen A, Oksala N. Risk factors associated with acute kidney injury in a cohort of 20,575 arthroplasty patients. Acta Orthop 2017; 88:370-376. [PMID: 28296531 PMCID: PMC5499326 DOI: 10.1080/17453674.2017.1301743] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patients developing postoperative acute kidney injury (AKI) are at risk of higher morbidity and mortality. In arthroplasty patients, many pre- and perioperative factors are associated with AKI but some of the risk factors are unclear. We report the incidence of postoperative AKI, the conditions associated with it, and survival rates in AKI patients. Patients and methods - We obtained data from 20,575 consecutive hip or knee arthroplasties. Postoperative AKI, occurring within 7 days after the operation, was defined using the risk, injury, failure, loss, and end-stage (RIFLE) criteria. We analyzed independent risk factors for AKI using binary logistic regression. In addition, we reviewed the records of AKI patients and performed a survival analysis. Results - The AKI incidence was 3.3 per 1,000 operations. We found preoperative estimated glomerular filtration rate, ASA classification, body mass index, and duration of operation to be independent risk factors for AKI. Infections, paralytic ileus, and cardiac causes were the predominant underlying conditions, whereas half of all AKI cases occurred without any clear underlying condition. Survival rates were lower in AKI patients. Interpretation - Supporting earlier results, existing renal insufficiency and patient-related characteristics were found to be associated with an increased risk of postoperative AKI. Furthermore, duration of operation was identified as an independent risk factor. We suggest careful renal monitoring postoperatively for patients with these risk factors.
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Affiliation(s)
- Pyry Jämsä
- Coxa Hospital for Joint Replacement;,Correspondence:
| | - Esa Jämsen
- Coxa Hospital for Joint Replacement;,School of Medicine, University of Tampere
| | - Leo-Pekka Lyytikäinen
- School of Medicine, University of Tampere;,Department of Clinical Chemistry, University of Tampere;,Fimlab Laboratories
| | | | | | - Niku Oksala
- School of Medicine, University of Tampere;,Department of Surgery, Faculty of Medicine and life sciences, Tampere University Hospital, Tampere, Finland
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Johansson S, Christensen OM, Thorsmark AH. A retrospective study of acute kidney injury in hip arthroplasty patients receiving gentamicin and dicloxacillin. Acta Orthop 2016; 87:589-591. [PMID: 27648882 PMCID: PMC5119441 DOI: 10.1080/17453674.2016.1231008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Acute kidney injury is a known complication of antibiotic use. Antibiotic prophylaxis is essential to prevent periprosthetic infections after total hip replacement. We experienced a rise in the incidence of acute kidney injury (AKI), and in an effort to solve this problem, we changed our antibiotic prophylaxis protocol. We investigated whether removing gentamicin from our antibiotic protocol would cause fewer and less severe cases of renal impairment. Patients and methods - We performed a retrospective study involving 136 cases of total hip replacement, with 66 patients receiving dicloxacillin and gentamicin and 70 patients receiving dicloxacillin alone. Results - We found less cases of AKI in the dicloxacillin group (p = 0.03): the mean creatine level in the dicloxacillin/gentamicin group was 126 (25-422) μmol/L whereas it was 93 (39-278) μmol/L in the group that received dicloxacillin alone. We also found that cases were less severe in the dicloxacillin group than in the dicloxacillin/gentamicin group (p = 0.02). The relative risk of developing AKI was 3 times higher if dicloxacillin and gentamicin were both used (p = 0.02). Interpretation - After removing gentamicin, there were fewer and less severe cases of acute kidney injury.
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Schiffl H, Lang SM. Obesity, acute kidney injury and outcome of critical illness. Int Urol Nephrol 2016; 49:461-466. [DOI: 10.1007/s11255-016-1451-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
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