Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

Abar, Orchideh; Toossi, Nader; Johanson, Norman A.

doi:10.1016/j.artd.2018.05.002

Cited by 18 publications

(16 citation statements)

References 24 publications

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“…Reported risk factors for AKI in patients undergoing THA are demonstrated in Table 2 [18,19,20,22,23,24,26,27,29,30,31,32,33,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Older age [23,24,26,29,31,55,60], higher body mass index (BMI) [19,22,23,24,26,30,31,46,47,48,49,56,57,59], reduced baseline estimated glomerular filtration rate (eGFR)/chronic kidney disease (CKD) [31,54,55,57,60], diabetes mellitus (DM) [24,26,31,34,47,55,57], nonsteroidal anti-inflammatory drug (NSAID) [23,32,53] use, and perioperative blood transfusion [23,47,53,…”

Section: Resultsmentioning

confidence: 99%

“…Similar to other types of perioperative AKI, the pathogenesis of THA-related AKI is multifactorial including intraoperative hypotension, perioperative anemia and blood transfusion, antibiotic-related AKI, and nephrotoxic agents such as NSAID use [18,19,20,22,23,24,26,27,29,30,31,32,33,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Our study demonstrated an overall low incidence of AKI following THA of 6.3%, and comparatively much lower than AKI incidence following other types of major surgeries such as coronary artery bypass grafting (AKI incidence approximately 20%) [63,64], vascular surgery (AKI incidence approximately 25%) [35,65], or heart valve replacement surgery (AKI incidence approximately 35% to 47%) [66].…”

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Thongprayoon

Kaewput

Thamcharoen

et al. 2019

JCM

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Thongprayoon

Kaewput

Thamcharoen

et al. 2019

JCM

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“…Whilst other studies have examined potential risk factors for AKI in orthopaedic patients [7][8][9], there is limited evidence to guide targeted intervention strategies to reduce AKI risk. Identification of patients at high risk of AKI is particularly important in a financially constrained heath system such as the NHS, where the significant increased cost associated with AKI has negative implications for population health and economics.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Farrow

Smillie

Duncumb

et al. 2021

Eur J Orthop Surg Traumatol

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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.

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“…AKI patients stayed an additional two days in hospital compared to non AKI patients (12.0 (3.7–20.3) days for AKI vs. 9.8 (1.9–17.7) days for non AKI patients), consistent with previous findings 47 . Patients that develop AKI following elective total joint arthroplasty also have increased hospital stay 48 . The management of patients with AKI is a significant burden to the healthcare service 49 .…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury risk in orthopaedic trauma patients pre and post surgery using a biomarker algorithm and clinical risk score

Kurth

McBride

McLean

et al. 2020

Sci Rep

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Acute kidney injury (AKI) after major trauma is associated with increased mortality. The aim of this study was to assess if measurement of blood biomarkers in combination with clinical characteristics could be used to develop a tool to assist clinicians in identifying which orthopaedic trauma patients are at risk of AKI. This is a prospective study of 237 orthopaedic trauma patients who were consecutively scheduled for open reduction and internal fixation of their fracture between May 2012 and August 2013. Clinical characteristics were recorded, and 28 biomarkers were analysed in patient blood samples. Post operatively a combination of H-FABP, sTNFR1 and MK had the highest predictive ability to identify patients at risk of developing AKI (AUROC 0.885). Three clinical characteristics; age, dementia and hypertension were identified in the orthopaedic trauma patients as potential risks for the development of AKI. Combining biomarker data with clinical characteristics allowed us to develop a proactive AKI clinical tool, which grouped patients into four risk categories that were associated with a clinical management regime that impacted patient care, management, length of hospital stay, and efficient use of hospital resources.

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Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

Cited by 18 publications

References 24 publications

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Acute kidney injury risk in orthopaedic trauma patients pre and post surgery using a biomarker algorithm and clinical risk score

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