Introduction: Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion.Methods: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin ,7 g/dL), and blood transfusion.Results: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups.Discussion: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with

Background: This retrospective study compared the change in serum creatinine between African American and Caucasian Total Knee Arthroplasty (TKA) patients. The authors hypothesized that African Americans would demonstrate significantly greater change, and that a significantly greater proportion would demonstrate creatinine changes consistent with acute kidney injury (AKI). Methods: Primary TKAs performed at a single institution between July, 2011-June, 2016 were identified: 1035 primary TKAs met inclusion and exclusion criteria (110 African American, 925 Caucasian, excluding Hispanic and Asian patients). None were excluded based on sex, age, BMI, preoperative diagnosis or comorbidities. All patients had pre-operative and post-operative creatinine levels available in the EMR. Each patient received the same pre-op and post-op protocol for NSAID use along with other drugs administered including anesthesia. All patients received 1 gram of IV (intravenous) vancomycin with some patients additionally receiving 1 gram of vancomycin powder administered locally at the end of surgery. All patients were controlled for fluid intake and blood loss, along with no patient receiving a transfusion or IV contrast. Patient demographics and pre/postoperative serum creatinine were recorded then analyzed for presence of AKI (≥0.3mg/dL). Pre/postoperative serum creatinine concentrations were compared between African American and Caucasian patients using 2×2 repeated measures ANOVA. Prevalence of patients in each group demonstrating AKI was calculated using Fisher Exact test. Results: African American patients had significantly greater serum creatinine preoperatively (1.00±0.26 vs. 0.90±0.22, p<0.001) and a significantly greater increase postoperatively (0.10 vs. 0.03, p<0.001). A significantly greater number of African American patients demonstrated AKI (10.9% vs. 5.1%, p=0.03). Furthermore, a significantly greater number of African American patients stayed in the hospital an additional 2 or more days for renal issues (2.7% vs. 0.4%, p=0.03).

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