Acute Renal Failure in Orthopaedic Surgery

Mavrogenis, Andreas F.; Mitsiokapa, Evanthia; Romantini, Matteo; Grandinetti, Valeria; Coll-Mesa, Luis; Ruggieri, Pietro; Papagelopoulos, Panayiotis J.

doi:10.1615/jlongtermeffmedimplants.v21.i2.50

Cited by 4 publications

(6 citation statements)

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“…Our results are consistent with other previously published reports on this subject [4,30,38] finding an increase in postoperative kidney injury with multiple antibiotic prophylaxis. Furthermore, our data also show the effect that hip and knee arthroplasty can have on patients.…”

Section: Discussionsupporting

confidence: 94%

“…We also found higher ASA classification and preoperative kidney disease to be independent predictors of AKI postoperatively consistent with prior literature, which reports that medical comorbidities and preoperative kidney function can lead to kidney injury after orthopaedic surgery [30]. Jafari et al [18] found that preoperative kidney disease and medical comorbidities predisposed patients to developing AKI after primary TJA.…”

Section: Discussionsupporting

confidence: 90%

“…Blood loss, transient hypotension, and predisposing host factors (ASA classification and preoperative renal disease) can cause transient renal dysfunction even when vancomycin is not used. The addition of nephrotoxic antibiotics such as vancomycin or gentamycin can stress the patient with borderline kidney functions and precipitate AKI postoperatively [30]. Finally, we previously showed in this series of patients that the addition of vancomycin to the prophylactic antibiotic regimen does not decrease the rate of SSI compared with cefazolin alone [36].…”

Section: Discussionmentioning

confidence: 78%

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Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background With increasing prevalence of methicillinresistant Staphylococcus aureus (MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients. Questions/purposes The purpose of this study was to determine whether patients receiving antibiotic prophylaxis with cefazolin and vancomycin have a higher risk of postoperative acute kidney injury (AKI) compared with patients receiving cefazolin alone before elective primary hip and knee arthroplasty. We also aimed to compare severity and recovery of AKI in these two cohorts and to determine independent risk factors for AKI. Methods We retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis. During the study period, a perceived high prevalence of MRSA infections at our institution led some surgeons to add vancomycin to the prophylactic antibiotic regimen. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were similar between the two groups. We defined AKI according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI in both groups was compared. We also compared the proportions of patients by AKIN severity stage and assessed recovery as defined by creatinine levels showing kidney function reaching 50% baseline. The American Society of Anesthesiologists (ASA) classification, preoperative chronic kidney disease, intraoperative fluid requirements, and estimated blood loss were recorded. We analyzed the data using a multivariate logistic regression model to identify potential independent risk factors, including dual antibiotic therapy. Results Patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002). Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p = 0.003). There was no difference in the rate of return to baseline renal function (2 ± 1.4 days versus 3 ± 3.4 days; mean difference, 0.5 days; 95% confidence interval [CI], À0.2 to 1.2 days; p = 0.155). Controlling for confounding variables, dual antibiotic prophylaxis (adjusted odds ratio [OR], 1.82; 95% CI, 1.25-2.64; p = 0.002), ASA class

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Moreover, major abdominal surgery can cause an increase of intra-abdominal pressure, linked to an increase in capillary permeability and interstitial fluid accumulation or to a diminished abdominal wall compliance that, in turn, causes intrarenal vascular congestion with a reduction in renal perfusion [83]. On the other side, orthopedic patients include often very aged people with severe co-morbidities (i.e., hypertension, renal failure, diabetes) that easily expose them to an increased risk of postoperative AKI [93]. Recent findings suggest that advanced age, hypertension, general anesthesia, and low intraoperative arterial pressure are all risk factors for AKI after joint replacement surgery [94].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis

et al. 2019

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Background: Perioperative goal-directed therapy (GDT) reduces the risk of renal injury. However, several questions remain unanswered, such as target, kind of patients and surgery, and role of fluids and inotropes. We therefore update a previous analysis, including all studies published in the meanwhile, to clarify the clinical impact of this strategy on acute kidney injury. Main body: Randomized controlled trials enrolling adult patients undergoing major surgery were considered. GDT was defined as perioperative monitoring and manipulation of hemodynamic parameters to reach normal or supranormal values by fluids alone or with inotropes. Trials comparing the effects of GDT and standard hemodynamic therapy were considered. Primary outcome was acute kidney injury, whichever definition was used. Meta-analytic techniques (analysis software RevMan, version 5.3) were used to combine studies, using random-effect odds ratios (OR) and 95% confidence intervals (CI). Trial sequential analyses were performed including all trials and considering only low risk of bias trials. Sixty-five trials with an overall sample of 9308 patients were included. OR for the development of renal injury was 0.64 (95% CI, 0.62-0.87; p = 0.0003), with no statistical heterogeneity. Trial sequential analyses and sensitivity analysis including studies with low risk of bias confirmed the main results. A significant decrease in renal injury rate was observed in studies that adopted cardiac output and oxygen delivery as hemodynamic target and that used both fluids and inotropes. The postoperative kidney injury rate was significantly lower in trials enrolling "high-risk" patients and major abdominal and orthopedic surgery. Short conclusion: The present meta-analysis suggests that targeting GDT to perioperative systemic oxygen delivery, by means of fluids and inotropes, can be the best way to improve renal perfusion and oxygenation in high-risk patients undergoing major abdominal and orthopedic surgery.

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“…The HTO group showed significantly low infection rate, which may be related to a relatively short operation time [ 22 – 24 ] and showed low risk of DVT possibly due to routine usage of mechanical compression after surgery [ 25 ], and pharmacologic prophylaxis [ 26 ]. There have been previous studies on factors related to ARF after orthopedic surgery, but studies related to different surgical methods, especially artificial joint surgery, have been insufficient and may require further evaluation [ 27 , 28 ]. On the other hand, cemented knee arthroplasty, as one of the independent risk factors for postoperative ICU admission in some studies could relate that the result of higher ICU admission in UKA as shown in Table 4 [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea

Lee

Kim

Seo

et al. 2022

BMC Musculoskelet Disord

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Background Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients. Methods We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI). Results Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO. Conclusions It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.

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Acute Renal Failure in Orthopaedic Surgery

Cited by 4 publications

References 0 publications

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis

A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea

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