Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

Warth, Lucian C.; Noiseux, Nicolas; Hogue, Matthew; Klaassen, Alison L.; Liu, Steve S.; Callaghan, John J.

doi:10.1016/j.arth.2015.08.012

Cited by 44 publications

(38 citation statements)

References 17 publications

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“…The incidence of AKI is within the range of recent reports, that is, from 0.5% to 6.2% [14], [23], [24], [25]. In this study, each patient who developed AKI was matched to a control group based on age, race, gender, and comorbidities such as HTN and diabetes.…”

Section: Discussionmentioning

confidence: 92%

Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

2018

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BackgroundAcute kidney injury (AKI) is a serious complication after major surgery, which may lead to increased morbidity and mortality. The aim of this study was to identify cost and determinants of AKI after total joint arthroplasty.MethodsA retrospective case-controlled study was conducted with 1719 primary elective total hip or knee replacements performed from January 2004 through September 2015 at an urban teaching hospital. Patients who developed AKI were matched in a 1:3 ratio with those in a control group who did not develop AKI based on age, sex, race, operated joint, and comorbidities including hypertension and diabetes. Increased postoperative serum creatinine was considered indicative of AKI.ResultsFifty-four patients (3.1%) had AKI that was significantly associated with increased length of hospital stay (8.07 days) compared with that of the control group (4.50 days, P < .0001) and incurred significantly higher hospital charges ($224,533) than those of the control group ($142,753, P < .0001). We identified high body mass index, undergoing bilateral surgery in one session, high estimated blood loss, and longer duration of surgery as significant risk factors for AKI in univariate analysis. Elevated preoperative creatinine, large postoperative drop in hemoglobin, and high American Society of Anesthesiologists physical status scores were significant independent predictors of AKI in multivariate analysis.ConclusionsHealth-care providers and patients should work together to manage risk factors and to lower the risk of morbidity and mortality, longer in-hospital stay, and high associated costs of AKI.

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Section: Discussionmentioning

confidence: 92%

Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

2018

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“…Patients taking β‐blockers may be at risk of intra‐operative hypotension and bradycardia, and in those with rate‐dependent cardiac outputs or other risk factors, consideration may be given to suspending these . The use of non‐steroidal anti‐inflammatory agents should be balanced against the potential for AKI and the presence of other risk factors, as there is, for example, evidence for an increased incidence of AKI in patients undergoing hip arthroplasty where these agents are used to provide analgesia .…”

Section: The Pre‐operative Approachmentioning

confidence: 99%

Renal complications of anaesthesia

2018

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SummaryPeri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated.

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“…Along with opioid-sparing effects, NSAIDs are associated with negative effects such as possible increased risk of bleeding and acute renal failure (Blouin & Rhainds, 2014;Shukla, Rai, Prasad, & Agarwal, 2017;Van Koughnett & Wexner, 2014;Warth et al, 2016). Patients should be carefully evaluated for potential risks for adverse events with NSAIDs.…”

Section: Rationalementioning

confidence: 99%

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Jungquist

Quinlan-Colwell

Vallerand

et al. 2020

Pain Management Nursing

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a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

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Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

Cited by 44 publications

References 17 publications

Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

Cost and determinants of acute kidney injury after elective primary total joint arthroplasty

Renal complications of anaesthesia

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

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