Yeungnam Univ J Med.  2021 Apr;38(2):136-141. 10.12701/yujm.2020.00542.

Analysis of the risk factors of acute kidney injury after total hip or knee replacement surgery

• Lee YJ
• Park BS
• Park S
• Park JH
• Kim IH
• Ko J
• Kim YW

• KMID: 2515187
• DOI: http://doi.org/10.12701/yujm.2020.00542

Abstract

Background
Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery.
Methods
This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016.
Results
AKI occurred in 13 (3.7%) of the 351 patients. The patients’ preoperative estimated glomerular filtration rate (eGFR) was 66.66±34.02 mL/min/1.73 m2 in the AKI group and 78.07±21.23 mL/min/1.73 m2 in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02–0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61–0.89; p=0.002).
Conclusion
Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

Keyword

Acute kidney injury; Orthopedic procedures; Postoperative complications; Risk factors

Figure

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  Fig. 1. Efficacy rates of changes in estimated glomerular filtration rate (ΔeGFR) for detecting acute kidney injury. AUC, area under the receiver-operating characteristic (ROC) curve; SE, standard error; CI, confidence interval.

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