Postoperative Acute Kidney Injury With Dual NSAID Use After Outpatient Primary Total Joint Arthroplasty

Abstract

Background:NSAIDs have been shown to be highly effective analgesic agents in the postoperative period. NSAIDs do have several potential adverse effects, including kidney injury (AKI). Little is known about AKI in the outpatient total joint arthroplasty (TJA) setting, where patient labs are not closely monitored. The objective of this study was to evaluate the renal safety of combined use of ibuprofen for pain control and aspirin for deep vein thrombosis chemoprophylaxis after outpatient primary TJA.Methods:Patients undergoing primary total hip or total knee arthroplasty between January 2020 and July 2020 at a single center were included for analysis. All included patients were discharged on a standard regimen including aspirin 81 mg twice a day and ibuprofen 600 mg three times a day. Patients were ordered a serum creatinine test at 2 and 4 weeks postoperatively. Patients with postoperative acute kidney injury were identified per Acute Kidney Injury Network criteria.Results:Between January 23, 2020, and August 30, 2020, 113 patients were included in this study, of whom creatinine levels were measured in 103 patients (90.3%) at the 2-week postoperative time point, 58 patients (50.9%) at the 4-week time point, and 48 (42.1%) at combined 2- and 4-week time points. Three patients (2.9%) were found to have an AKI.Conclusion:This study found a rate of AKI of 2.9% with the use of dual NSAID therapy postoperatively after primary TJA. All cases occurred at 2 weeks postoperatively and saw spontaneous resolution.

Association between perioperative flurbiprofen administration and acute kidney injury (AKI) in spine surgery: a retrospective cohort study

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively utilized for postoperative analgesia and are included in the World Health Organization's pain ladder (Lubis et al 2021 ; Mittal et al 2022 ). Despite their benefits, NSAIDs are associated with an increased risk of bleeding, cardiovascular events, and acute kidney injury (AKI) (O'Connor et al 2016 ; Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case–control study.…”

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

“…However, these studies were limited by a focus on a single NSAID, or by grouping all NSAIDs together without parsing out the specific risks associated with each combination [13,17,18]. A recently published single-institution study examined the renal complications of the combined use of ibuprofen with aspirin, but it did not investigate other postoperative complications nor other combinations of NSAIDs [19]. Therefore, the purpose of this study was to determine the adverse effects of commonly used inpatient NSAID combinations, and to-in particular-determine which specific combinations demonstrate the highest risk profiles regarding AKI, GI bleeds, and atherothrombotic events.…”