Prevalence and risk factors for perioperative complications of CKD patients undergoing elective hip surgery

Abstract

PurposeChronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients.Material and methodsFrom 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications.ResultsThere were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers.ConclusionCompared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions.

Association between anesthesia technique and complications after hip surgery in the elderly population

“…High BMI is associated with surgical site infection after total hip arthroplasty[ 29 ], and BMI classification is a predictor of early postoperative complications[ 30 ]. A history of alcohol consumption is an independent risk factor for blood transfusion after hip surgery[ 31 ]. Since our data were obtained from electronic medical records, it was not feasible to obtain these variables.…”

Preoperative Intravenous Iron and Erythropoietin to Treat Severe Anemia in Patient With Stage 4 Kidney Disease Before Oncologic Surgery: A Case Report

“…In 1 study, patients with CKD had higher rates (50% vs 28.5%) of perioperative transfusions compared to non-CKD patients. 8 In another study, patients with CKD who had lower preoperative Hg had increased odds (0.74) of perioperative transfusions. 9 Our patient therefore had a very high risk of perioperative transfusions given that she had both advanced CKD and severe anemia.…”

Investigational study of the clinical characteristics of confirmed COVID-19 cases

“…Furthermore, it is theorized that COVID-19 enters the human cell due to an enzyme that is copious in renal tubular cells called angiotensin-converting enzyme 2 (ACE2) [ 13 ]. The complexity of COVID-19 has imparted challenges in preparing and managing CKD patients based on their perioperative complications compared with non-CKD patients [ 14 ]. It was concluded in one study that patients receiving preoperative angiotensin axis blockade (AAB) undergoing major elective orthopedic surgery have increased probability of post-induction hypotension and postoperative acute kidney injury that leads to prolonged hospital length of stay [ 15 ].…”