1
|
Lung B, Callan K, McLellan M, Kim M, Yi J, McMaster W, Yang S, So D. The impact of dehydration on short-term postoperative complications in total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:15. [PMID: 36611176 PMCID: PMC9825029 DOI: 10.1186/s12891-022-06118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND As healthcare economics shifts towards outcomes-based bundled payment models, providers must understand the evolving dynamics of medical optimization and fluid resuscitation prior to elective surgery. Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total knee arthroplasty (TKA) to reduce postoperative complications and inpatient costs. METHODS All primary TKA from 2005 to 2019 were queried from the National Surgical Quality Improvement Program (NSQIP) database, and patients were compared based on dehydration status: Blood Urea Nitrogen Creatinine ratio (BUN/Cr) < 20 (non-dehydrated), 20 ≤ BUN/Cr ≤ 25 (moderately-dehydrated), 25 < BUN/Cr (severely-dehydrated). A sub-group analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed. RESULTS The analysis included 344,744 patients who underwent TKA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of non-home discharge, postoperative transfusion, postoperative deep vein thrombosis (DVT), and increased length of stay (LOS) (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of non-home discharge, progressive renal insufficiency, urinary tract infection (UTI), postoperative transfusion, and extended LOS (all p < 0.01). CONCLUSION BUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. LEVEL OF EVIDENCE Level III; Retrospective Case-Control Design; Prognosis Study.
Collapse
Affiliation(s)
- Brandon Lung
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - Kylie Callan
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - Maddison McLellan
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - Matthew Kim
- grid.36425.360000 0001 2216 9681Department of Orthopaedic Surgery, Stony Brook University School of Medicine, NY Stony Brook, USA
| | - Justin Yi
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - William McMaster
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - Steven Yang
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| | - David So
- grid.266093.80000 0001 0668 7243Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Dr S Pavilion 3, CA 92868 Orange, USA
| |
Collapse
|
2
|
Patel M, Gbadegesin RA. Update on prognosis driven classification of pediatric AKI. Front Pediatr 2022; 10:1039024. [PMID: 36340722 PMCID: PMC9634036 DOI: 10.3389/fped.2022.1039024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.
Collapse
Affiliation(s)
- Mital Patel
- Department of Pediatrics, Division of Pediatric Nephrology, Duke University, Durham, NC, United State
| | | |
Collapse
|
3
|
Shaw AD, Khanna AK, Smischney NJ, Shenoy AV, Boero IJ, Bershad M, Hwang S, Chen Q, Stapelfeldt WH. Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study. Br J Anaesth 2022; 129:13-21. [PMID: 35595549 DOI: 10.1016/j.bja.2022.03.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Whilst intraoperative hypotension is associated with postoperative acute kidney injury (AKI), the link between intraoperative hypotension and acute kidney disease (AKD), defined as continuing renal dysfunction for up to 3 months after exposure, has not yet been studied. METHODS We conducted a retrospective multicentre cohort study using data from noncardiac, non-obstetric surgery extracted from a US electronic health records database. Primary outcome was the association between intraoperative hypotension, at three MAP thresholds (≤75, ≤65, and ≤55 mm Hg), and the following two AKD subtypes: (i) persistent (initial AKI incidence within 7 days of surgery, with continuation between 8 and 90 days post-surgery) and (ii) delayed (renal impairment without AKI within 7 days, with AKI occurring between 8 and 90 days post-surgery). Secondary outcomes included healthcare resource utilisation for patients with either AKD subtype or no AKD. RESULTS A total of 112 912 surgeries qualified for the study. We observed a rate of 2.2% for delayed AKD and 0.6% for persistent AKD. Intraoperative hypotension was significantly associated with persistent AKD at MAP ≤55 mm Hg (hazard ratio 1.1; 95% confidence interval: 1.38-1.22; P<0.004). However, IOH was not significantly associated with delayed AKD across any of the MAP thresholds. Patients with delayed or persistent AKD had higher healthcare resource utilisation across both hospital and intensive care admissions, compared with patients with no AKD. CONCLUSIONS Intraoperative hypotension is associated with persistent but not delayed acute kidney disease. Both types of acute kidney disease appear to be associated with increased healthcare utilisation. Correction of intraoperative hypotension is a potential opportunity to decrease postoperative kidney injury and associated costs.
Collapse
Affiliation(s)
- Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA.
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Nathan J Smischney
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Qinyu Chen
- Boston Consulting Group, Boston, MA, USA
| | - Wolf H Stapelfeldt
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA; Anesthesiology Services, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| |
Collapse
|
4
|
The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip and knee arthroplasty (HKA) is a surgical procedure when damaged parts of the joint are replaced with artificial ones that replicate the shape of a normal joint and restore its function.
Every year more than 1.5 million endoprosthetic operations are performed in the world. Replacement of a damaged joint allows patients to return to the normal life, freeing from pain and limited mobility. However, one of the common diseases that negatively affect the results of these operations is diabetes mellitus (DM).
The aim of the study: to determine the efficacy and safety of the combined multimodal low opioid anesthesia with dexmedetomidine sedation in patients with diabetes undergoing HKA surgery.
Materials and methods. The study included 45 patients who underwent HKA surgery. Patients were divided into three groups according to the scheme of anesthesia. In patients of the 1st group (n = 15) multicomponent low-flow anesthesia with artificial lung ventilation was performed, in the patients of the 2nd group (n = 15) spinal anesthesia was used, in the 3rd group (n = 15) – combined spinal – epidural anesthesia with dexmedetomidine sedation.
The groups of patients were identical in anthropometric and gender characteristics, duration of surgery and anesthesia, baseline somatic status.
Statistical analysis was performed using the IBM SPSS Statistics suite (SPSS v.16.0).
Results. The course of anesthesia in patients in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting (PONV). Only one patient from group 3 required ondansetron for the treatment of PONV against 3 and 2 patients from groups 1 and 2, respectively (p <0.05).
Conclusions. Any of the proposed techniques can be used for anesthesia during hip and knee arthroplasty, but the best results have been obtained with combined spinal-epidural anesthesia with dexmedetomidine sedation. In addition, the use of dexmedetomidine can significantly reduce the use of opioids diring the intraoperative and postoperative period.
Collapse
|
5
|
Varghese PP, Chen C, Gordon AM, Magruder ML, Vakharia RM, Erez O, Razi AE. Complications, readmission rates, and in-hospital lengths-of-stay in octogenarian vs. non-octogenarians following total knee arthroplasty: An analysis of over 1.7 million patients. Knee 2022; 35:213-219. [PMID: 35381573 DOI: 10.1016/j.knee.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Studies investigating complications between octogenarians and non-octogenarians undergoing primary total knee arthroplasty (TKA) are limited. Therefore, we investigated whether octogenarians are at greater odds of: (1) in-hospital lengths of stay (LOS) (2) readmission rates, (3) medical complications, and (4) hardware complications compared to non-octogenarians following TKA. METHODS A retrospective query of the PearlDiver database isolated 1,775,460 patients who underwent primary TKA from 2005 to 2014. Patients aged 80 and above represented the study cohort (n = 295,908) and patients 65 to 79 represented the control cohort (n = 1,479,552). Study group patients were matched to controls in a 1:5 ratio according to gender and medical comorbidities. Pearson's Chi Square and logistic regression were used to analyze the primary outcomes of the study which included 90-day medical complications, 90-day readmission rates, 2-year implant-related complications, and in-hospital LOS. A p-value less than 0.001 was statistically significant. RESULTS Octogenarians were found to have significantly higher incidence and odds of 90-day readmission rates (10.59 vs. 9.35%; OR: 1.15, p < 0.0001) and significantly longer in-hospital LOS (3.69 days ± 1.95 vs. 3.23 days ± 1.83, p < 0.0001) compared to controls. Octogenarians also had equal incidence and odds of developing any medical complication (1.26 vs. 1.26%; OR: 0.99, p = 0.99) and lower incidence and odds (1.67 vs. 1.93%; OR: 0.86, p < 0.001) of implant-related complications compared to controls. CONCLUSION Octogenarians undergoing primary TKA have similar odds of medical related complications and lower odds of implant-related complications compared to non-octogenarian patients, whereas readmission rates and in-hospital LOS are greater.
Collapse
Affiliation(s)
- Priscilla P Varghese
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States; State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY, United States
| | - Christine Chen
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States; State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY, United States
| | - Adam M Gordon
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States.
| | - Matthew L Magruder
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States
| | - Rushabh M Vakharia
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States
| | - Orry Erez
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, NY, United States
| |
Collapse
|
6
|
Sundaram K, Warren JA, Krebs OK, Anis HK, Klika AK, Molloy RM, Higuera-Rueda CA, Barsoum WK, Piuzzi NS. Estimated glomerular filtration rate is a prognosticator of adverse outcomes after primary total knee arthroplasty among patients with chronic kidney disease and glomerular hyperfiltration. Knee 2021; 28:36-44. [PMID: 33285425 DOI: 10.1016/j.knee.2020.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/24/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goals of this study were: (1) to test whether patients with an Estimated glomerular filtration rate (eGFR) that is higher or lower than population-based standards have an increased risk of 30-day mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications after primary total knee arthroplasty (TKA); and (2) to find out whether there is a significant non-linear relationship between eGFR and those same variables. METHODS A total of 168,919 primary TKAs were identified using The National Surgical Quality Improvement Program (NSQIP) database between 1 January 2008 and 31 December 2016. The following outcomes were assessed at 30 days: mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications. RESULTS Multivariate binomial logistical regression found that patients with hyperfiltration had higher rates of readmission (P < 0.03), non-home discharge (P < 0.01), any complication (P < 0.01), major complications (P = 0.03), and minor complications (P < 0.01) compared to reference patients with eGFR in the normal range. Patients with an eGFR less than 60 (stage 3 chronic kidney disease or higher) had increased odds of mortality (P < 0.05), readmission (P < 0.05), any complication (P < 0.01), major complications (P < 0.01), and minor complications (P < 0.01). Spline regression found statistically significant non-linear relationships between eGFR and mortality (P < 0.001), return to the operating room (P = 0.0029), and readmission as well as non-home discharge (P < 0.001). CONCLUSION Low eGFR and hyperfiltration may be associated with elevated risk of 30-day adverse events. GFR can be used as a risk stratification tool to counseling patients with particular attention paid to those with a GFR < 30 ml/min/1.73 m2.
Collapse
Affiliation(s)
- Kavin Sundaram
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Jared A Warren
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Olivia K Krebs
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Hiba K Anis
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Alison K Klika
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Robert M Molloy
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA
| | | | - Wael K Barsoum
- Cleveland Clinic Florida, Department of Orthopedic Surgery, Weston, FL, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
| |
Collapse
|
7
|
Yasin MS, Farah RI, Hammad Y, Isleem UN, Yaghi RT, Zughoul BM, Alobaidi MM, Alqudah MA. Determining the risk of acute kidney injury in patients who underwent total joint replacement: A retrospective study. J Orthop Sci 2020; 25:1029-1034. [PMID: 32014344 DOI: 10.1016/j.jos.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/23/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Total joint replacement (TJR) is a commonly performed procedure worldwide, and postoperative acute kidney injury (AKI) is one of the complications that determine the overall prognosis in various surgical settings. We aimed to identify the risk of AKI after TJR (primary and revision) and determine the factors associated with postoperative AKI. METHODS We performed a retrospective study of 1068 patients (>18 years) who underwent TJR between 2014 and 2019 at a tertiary medical center. Patients' demographic, clinical, and laboratory data were reviewed. RESULTS A total of 1068 patients were included in this study [mean age, 60.5 ± 13 years; 260 men (24.3%); 808 women (75.7%)]. A total of 962 patients (90.1%) underwent primary joint replacement (PJR) and 106 underwent joint revision (9.9%). Sixty-six patients (6.2%) had postoperative AKI. Primary total hip replacement patients had a lower risk of AKI than patients with other types of TJR (3.0%; p = 0.024). The factors associated with AKI (adjusting for known confounders) included male gender [adjusted odds ratio (AOR): 1.751; 95% confidence interval (CI): 1.01-3.03; p = 0.046], diabetes mellitus (DM) [AOR: 2.806; 95% CI: 1.687-5.023; p ≤ 0.001], hypertension (HTN) [AOR: 1.751; 95% CI: 1.159-3.442; p = 0.013], and the use of vancomycin as a prophylactic antibiotic [AOR: 1.691; 95% CI: 1.1-2.913; p = 0.050]. Chronic kidney disease (CKD) [AOR: 1.00; 95% CI: 0.432-2.27; p = 0.981] was not found to be a significant risk factor. CONCLUSION In this study, the risk of preoperative AKI in patients who underwent TJR was 6.2%. Male gender, preoperative comorbidities such as DM and HTN, and preoperative use of vancomycin were associated with increased risk of postoperative AKI.
Collapse
Affiliation(s)
- Mohamad Samih Yasin
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Randa I Farah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Yazan Hammad
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Ula Nael Isleem
- School of Medicine, The University of Jordan, Amman, Jordan.
| | - Rami Tayseer Yaghi
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Basheer Mohammed Zughoul
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Mustafa Mohammed Alobaidi
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Mohammad Ali Alqudah
- Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
| |
Collapse
|
8
|
Chen G, Yan X, Huang Z, Liu L, Meng L, Li M, Liu J, Chen S, Li H, Mai Z, Chen E, Lai D, Wang B, Huang H, Tan N, Liu Y, Wei S, Chen J. Association of dialysis-requiring acute kidney injury with 90-day prognosis in patients with coronary artery disease and advanced kidney disease after coronary angiography. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1241. [PMID: 33178773 PMCID: PMC7607096 DOI: 10.21037/atm-20-6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dialysis-requiring acute kidney injury (AKI-D) is a potentially serious complication associated with high in-hospital mortality among patients with coronary artery disease (CAD) after coronary angiography (CAG). Patients with existing advanced kidney disease (AKD) have an increased risk of developing AKI-D. However, few studies have investigated the prognosis of AKI-D in patients with both CAD and AKD. METHODS In this observational study, 603 CAD patients with AKD (estimated glomerular filtration rate, eGFR <30 mL/min/1.73 m2) were enrolled. AKI-D was defined as acute or worsening renal failure requiring the initiation of renal dialysis. The primary endpoint was 90-day all-cause mortality. Kaplan-Meier and Cox regression analyses were used to assess the association of AKI-D and 90-day all-cause mortality among CAD patients complicated with AKD. RESULTS Overall, among 603 CAD patients complicated with AKD, 83 patients (13.8%) required AKI-D. Patients underwent AKI-D had a significantly higher rate of 90-day mortality than those who did not (13.3% vs. 6.5%, log rank P=0.028), with an unadjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI): 1.02-1.61, P=0.032]. After adjustment for cardiac and renal impairment, however, AKI-D was no longer associated with 90-day mortality (HR: 1.08, 95% CI: 0.84-1.39, P=0.559). The attenuation analysis showed that after adjustment for cardiac and renal function, the residual effect of 90-day mortality was as low as 30% of the unadjusted effect. CONCLUSIONS The incidence of AKI-D is high among patients with CAD complicated by AKD. The high 90-day mortality rate of patients undergoing AKI-D is mainly attributable to cardio-renal impairment.
Collapse
Affiliation(s)
- Guanzhong Chen
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoming Yan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liwei Liu
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangguang Meng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Min Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ziling Mai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Enzhao Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Disheng Lai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yong Liu
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shuisheng Wei
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| |
Collapse
|
9
|
Antoniak DT, Benes BJ, Hartman CW, Vokoun CW, Samson KK, Shiffermiller JF. Impact of Chronic Kidney Disease in Older Adults Undergoing Hip or Knee Arthroplasty: A Large Database Study. J Arthroplasty 2020; 35:1214-1221.e5. [PMID: 31948811 DOI: 10.1016/j.arth.2019.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/06/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip and knee arthroplasties are among the most commonly performed surgical procedures in the elderly. In this age group, uncertainty exists regarding the importance of mild to moderate chronic kidney disease (CKD), which is prevalent but often unrecognized in the perioperative setting. This study evaluates the association between mild to moderate CKD and adverse postoperative outcomes in patients 65 years or older METHODS: This retrospective study selected patients 65 years or older undergoing hip or knee arthroplasty between 2006 and 2016 from the National Surgical Quality Improvement Program database. We created logistic regression models to analyze the relationship between CKD stage and each of our coprimary outcomes. The primary outcomes were major complication and mortality occurring within 30 days of surgery. RESULTS Of the 193,747 included patients, 68,424 (35.3%) underwent hip and 125,323 (64.7%) knee arthroplasty. Within 30 days of surgery, 12,767 patients (6.6%) experienced a major complication and 352 (0.2%) died. Compared to patients with no kidney disease, patients with CKD stages 3b and 4 were at higher risk for both major complication (adjusted odds ratio [aOR] 1.28 [1.08-1.52], aOR 1.5 [1.13-1.98], respectively) and mortality (aOR 3.17 [1.23-8.14], aOR 3.93 [1.26-12.21], respectively) after hip arthroplasty, and for major complication (aOR 1.42 [1.23-1.63], aOR 1.52 [1.19-1.93], respectively) after knee arthroplasty. CONCLUSION Among elderly patients, stage 3b and stage 4 CKD were associated with 30-day postoperative major complication after hip or knee arthroplasty, and with 30-day postoperative mortality after hip, but not knee, arthroplasty. Further research will be required to inform perioperative management decisions.
Collapse
Affiliation(s)
- Derrick T Antoniak
- Department of Medicine, Section of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE; Department of Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE
| | - Brian J Benes
- Department of Medicine, Section of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Curtis W Hartman
- Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE
| | - Chad W Vokoun
- Department of Medicine, Section of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Kaeli K Samson
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Jason F Shiffermiller
- Department of Medicine, Section of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
10
|
Oh TK, Park JW, Shin HJ, Na HS, Oh AY, Hwang JW. Perioperative sedative use is not associated with acute kidney injury after total hip or knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:237. [PMID: 31317007 DOI: 10.21037/atm.2019.04.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The use of sedatives (propofol or dexmedetomidine) is common in total knee arthroplasty (TKA) or total hip arthroplasty (THA) under spinal anesthesia. Although propofol and dexmedetomidine have been reported to decrease the risk of acute kidney injury (AKI) after cardiac surgery, their effects on AKI incidence after TKA or THA are still unknown. The purpose of this study was to investigate the associations between sedative dosage (propofol and dexmedetomidine) and AKI incidence after TKA or THA under spinal anesthesia. Methods This retrospective observational study analyzed medical records of adult patients aged 18 years or older who underwent unilateral TKA or THA under spinal anesthesia at a single tertiary care hospital between January 2007 and June 2018. Data were analyzed using univariable and multivariable logistic regression analyses. Results A total of 5,663 patients were included in the analysis (TKA: 3,570, 63.0%; THA: 2,093, 37.0%), and 147 patients (2.6%) developed AKI in postoperative days 0-3. Multivariable logistic regression analysis showed that propofol dosage (odds ratio: 0.99, 95% confidence interval: 0.94, 1.05; P=0.839) and dexmedetomidine dosage (odds ratio: 0.95, 95% confidence interval: 0.84, 1.09; P=0.461) were not significantly associated with AKI incidence. Conclusions This study demonstrated no significant association between sedative uses (propofol, dexmedetomidine) and AKI incidence after THA or TKA under spinal anesthesia, and use of such sedatives does not require extreme caution.
Collapse
Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| |
Collapse
|