Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty

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

doi:10.1016/j.arth.2021.12.019

Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty

J Arthroplasty. 2022 Aug;37(8S):S1004-S1009. doi: 10.1016/j.arth.2021.12.019. Epub 2021 Dec 21.

Authors

Nathan R Angerett¹, Alexander Yevtukh², Christopher M Ferguson², Michael E Kahan¹, Muzaffar Ali², Richard H Hallock³

Affiliations

¹ Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Rubin Institute for Advanced Orthopedics, Center for Joint Preservation & Replacement, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD.
² Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA.
³ Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Orthopedic Institute of Pennsylvania, Camp Hill, PA.

PMID: 34952163
DOI: 10.1016/j.arth.2021.12.019

Abstract

Background: Perioperative hip and knee arthroplasty complications remain a significant clinical and financial burden. Our institution has shifted to developing protocols to decrease these perioperative complications. This study focuses on acute kidney injury (AKI) rate status post primary total joint arthroplasty (TJA). Current literature demonstrates a 2%-15% incidence of AKI following TJA. However, there is a paucity of published literature on protocols that have effectively reduced AKI rates following TJA. The purpose of this study is to evaluate the effect that our institutionally developed perioperative renal protocol had on the postoperative AKI rates.

Methods: A retrospective cohort study was performed. Patient demographics, baseline creatinine, and postoperative creatinine values during the patient's hospitalization were collected and analyzed. The preintervention cohort data contained all patients at our institution who underwent a primary TJA from November 1, 2016 to January 1, 2018. The postintervention cohort included all primary TJA patients from July 1, 2018 to February 2, 2020. AKI was defined using the AKI Network classification system comparing baseline and postoperative creatinine values. A multivariate analysis was performed to determine the statistical significance of our results.

Results: Before intervention 1013 patients underwent a primary TJA with 68 patients developing an AKI postoperatively. After intervention 2169 patients underwent primary TJA with 90 patients developing an AKI (6.71% vs 4.15%; P = .0015, odds ratio = 0.59, 95% confidence interval = 0.42-0.82).

Conclusion: This study demonstrated that implementation of a perioperative renal protocol can significantly reduce AKI rates. A reduction in AKI rates following TJA will result in improved outcomes and secondarily decrease the financial impact of postoperative complications seen following TJA.

Keywords: AKI; acute kidney injury; arthroplasty complication; perioperative management; renal protocol.

MeSH terms

Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Acute Kidney Injury* / prevention & control
Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Knee* / adverse effects
Creatinine
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Retrospective Studies
Risk Factors

Substances

Creatinine