Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty

Angerett, Nathan R.; Yevtukh, Alexander; Ferguson, Christopher M.; Kahan, Michael; Ali, Muzaffar; Hallock, Richard H.

doi:10.1016/j.arth.2021.12.019

Cited by 4 publications

(3 citation statements)

References 60 publications

(37 reference statements)

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“…Lastly, the duration of usage for each NSAID following discharge was not available in the PHD, and it likely varied based on common practice patterns. For example, toradol is often administered intravenously for a shorter duration than celecoxib and meloxicam, which are often given for extended durations postoperatively [34]. However, the focus of this study was to assess the risk profile of NSAID combinations in the way they are commonly used.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Nakata,

Shelby,

Wang

et al. 2023

JCM

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Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in multimodal pain control following total joint arthroplasty (TJA). However, few studies have assessed the complications associated with the combinations of NSAIDs in this population despite the known risks associated with this class of medications. The Premier Healthcare Database was queried to identify adults who underwent primary total hip or knee arthroplasty from 2005–2014. The following most common inpatient combinations of NSAIDs were chosen for analysis: aspirin + celecoxib (A + C), toradol + aspirin (T + A), toradol + ibuprofen (T + I), celecoxib + ibuprofen (C + I), ibuprofen + aspirin (I + A), and toradol + celecoxib (T + C). Primary outcomes included acute kidney injury (AKI), gastrointestinal bleed, and stroke. Secondary outcomes included periprosthetic joint infection (PJI), deep vein thrombosis, and pulmonary embolism. Univariate and multivariate regression analyses were used to compare differences and address confounds. Overall, 195,833 patients were identified. After controlling for confounds, increased odds of AKI was associated with A + C (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI]: 1.09–1.34, p < 0.001) and decreased odds was associated with T + A (aOR 0.76, 95% CI: 0.69–0.83, p < 0.001). Increased odds of stroke was associated with A + C (aOR: 1.80, 95% CI: 1.15–2.84, p = 0.011); T + I (aOR 3.48, 95% CI: 1.25–9.73, p = 0.017); and I + A (aOR 4.29, 95% CI: 1.06–17.9, p = 0.046). Increased odds of PJI was associated with C + I (aOR: 10.3, 95% CI: 1.35–78.3, p = 0.024). In the TJA patient population, NSAID pairings should be regarded as distinct entities. Our results suggest that combinations including A + C, T + I, I + A, and C + I should be used cautiously. With this knowledge, providers should consider tailoring NSAID prescriptions appropriately.

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Section: Discussionmentioning

confidence: 99%

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Nakata,

Shelby,

Wang

et al. 2023

JCM

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“…Предлагаемый периоперационный «ренальный протокол» предусматривает дооперационное выявление ХБП (по СКФ < 60 мл/мин/1,73 м 2 ), а также факторов риска со стороны сопутствующей патологии, коррекцию предоперационной анемии, ограничение вплоть до полной отмены нефротоксических препаратов (НПВС, антибиоти-Травматология Traumatology ков, гипотензивных препаратов и диуретиков), минимизацию кровопотери, контроль системной гемодинамики и гидробаланса, послеоперационный контроль СКФ [12,30]. Внедрение «ренального протокола» способствует снижению частоты послеоперационного ОПП, улучшению клинических и экономических результатов лечения [30]. Касаясь собственного опыта, «ренальный протокол» при первичном ТЭТС в клинике ИНЦХТ включает:…”

Section: срокиunclassified

Acute kidney injury after primary total hip replacement

Lebed,

Kirpichenko,

Novikova

et al. 2023

Acta biomedica scientifica

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Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys. The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology. Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021. Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group. Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration. Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase. Conclusions. Acute kidney injury was detected in 7.3 % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in patients of the study group included relatively low initial and minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m2 allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement.

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“…The renoprotective effect of albumin was mediated by scavenging reactive oxygen species, preventing oxidative damage, and binding and delivering protective lysophosphatidic acid (Wiedermann et al, 2010). In a recent study, Angerett NR et al (Angerett et al, 2022). reduced the incidence of AKI after TJA from 6.71% to 4.15% by implementing a perioperative renal protocol.…”

Section: Associated Factors Of Akimentioning

confidence: 99%

Incidence, associated factors, and outcomes of acute kidney injury following placement of antibiotic bone cement spacers in two-stage exchange for periprosthetic joint infection: a comprehensive study

Li,

Maimaiti,

Yang

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundTwo-stage exchange with placement of antibiotic cement spacer (ACS) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI), but it could cause a high prevalence of acute kidney injury (AKI). However, the results of the current evidence on this topic are too mixed to effectively guide clinical practice.MethodsWe retrospectively identified 340 chronic PJI patients who underwent the first-stage exchange with placement of ACS. The Kidney Disease Improving Global Outcomes guideline was used to define postoperative AKI. Multivariate logistic analysis was performed to determine the potential factors associated with AKI. Furthermore, a systematic review and meta-analysis on this topic were conducted to summarize the knowledge in the current literature further.ResultsIn our cohort, the incidence of AKI following first-stage exchange was 12.1%. Older age (per 10 years, OR= 1.509) and preoperative hypoalbuminemia (OR= 3.593) were independent predictors for postoperative AKI. Eight AKI patients progressed to chronic kidney disease after 90 days. A meta-analysis including a total of 2525 PJI patients showed the incidence of AKI was 16.6%, and AKI requiring acute dialysis was 1.4%. Besides, host characteristics, poor baseline liver function, factors contributing to acute renal blood flow injury, and the use of nephrotoxic drugs may be associated with the development of AKI. However, only a few studies supported an association between antibiotic dose and AKI.ConclusionAKI occurs in approximately one out of every six PJI patients undergoing first-stage exchange. The pathogenesis of AKI is multifactorial, with hypoalbuminemia could be an overlooked associated factor. Although the need for acute dialysis is uncommon, the fact that some AKI patients will develop CKD still needs to be taken into consideration.

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Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty

Cited by 4 publications

References 60 publications

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Acute kidney injury after primary total hip replacement

Incidence, associated factors, and outcomes of acute kidney injury following placement of antibiotic bone cement spacers in two-stage exchange for periprosthetic joint infection: a comprehensive study

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