Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Abstract

Purpose Recent research has outlined the increasing incidence of acute kidney injury (AKI) and its effect on morbidity/mortality. There is evidence that current rates are significantly under-reported nationally, with uncertainty about pre-operative factors that might influence AKI reduction and the impact on other healthcare outcomes such as mortality and later Chronic Kidney Disease (CKD) development. We set out to help address these current deficiencies in the literature. Methods A retrospective cohort study was undertaken using data collected from patients undergoing elective primary lower limb arthroplasty within our institution from 01/10/16–31/09/17 with a 2-year follow-up. Results 53/782 (6.8%) patients had an AKI during the study time period. This was associated with a longer inpatient stay (p < 0.001). There was no significant difference in 30-day mortality (p = 0.134), 30-day readmission (p = 1.00) or later CKD development (p = 0.63). Independent predictors of AKI were as follows: Diabetes (OR 2.49; 95%CI 1.15–5.38; p = 0.021), CKD (OR 4.59; 95%CI 2.37–8.92; p < 0.001) and Male sex (OR 2.61; 95%CI 1.42–4.78; p = 0.002). Conclusions AKI in those undergoing hip and knee arthroplasty remains under-reported at a national level. AKI development was associated with an increased length of stay, but not long-term healthcare outcomes. This may be due to the mechanism of AKI development or the low absolute numbers of AKI suffered. We have identified three pre-operative factors (Diabetes, CKD & Male Sex) that were independently predictive of AKI. Targeted interventions may reduce the risk of AKI after lower limb arthroplasty.

Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project

“…Our results regarding the number of risk factor drug classes prescribed concur with those of Bell et al , perhaps supporting our suggestion of a synergistic impact of these drugs on renal blood flow resulting in an increased risk of AKI 6. Our findings support those previously made with regard to the effect of postoperative AKI on length of hospital stay and postoperative mortality 1 3–5…”

“… 1–5 A large-scale cohort study estimated the incidence of AKI for postoperative T&O patients at 10.8%. 6 Studies focusing on AKI following elective procedures found rates of 6.8% 5 and 8.2% 1 compared with 17% of patients following emergency surgery. 3 7 Importantly, while undergoing an operation is in itself a risk factor for developing an AKI, emergency T&O patients in particular are often at greater risk, given their frailty and comorbidities.…”

“…Acute kidney injury (AKI) is a common postoperative complication in trauma and orthopaedic (T&O) patients, which leads to increased length of hospital stay, risk of other postoperative complications, morbidity and mortality 1–5. A large-scale cohort study estimated the incidence of AKI for postoperative T&O patients at 10.8% 6.…”

Incidence and predictors of acute kidney injury after elective surgery for lumbar degenerative disease: A 13-year analysis of the US Nationwide Inpatient Sample

“…As mentioned earlier, recent studies have shown an increase in the incidence of AKI and its impact on morbidity and mortality. 1,9,15,16 However, although potential risk factors for AKI have been examined in studies of orthopedic patients, only limited evidence is available to guide targeted intervention strategies aimed at reducing the risk of AKI. 15,17,18 Few studies have investigated AKI after spinal surgery, especially surgery for degenerative spinal disease.…”

“…1,9,15,16 However, although potential risk factors for AKI have been examined in studies of orthopedic patients, only limited evidence is available to guide targeted intervention strategies aimed at reducing the risk of AKI. 15,17,18 Few studies have investigated AKI after spinal surgery, especially surgery for degenerative spinal disease. The true incidence and predictors for AKI following degenerative spine surgery have yet to be evaluated.…”