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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 July;82(7):767-76
Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study
Lars S. BJERREGAARD 1, 2, Christoffer C. JØRGENSEN 1, 2, Henrik KEHLET 1, 2, on behalf of the Ludbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group ✉
1 Section for Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet Copenhagen University, Copenhagen, Denmark; 2 The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark
BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited.
METHODS: The aim of this paper was to describe the incidence and consequences of serious RU complications resulting in length of stay >4 days or 30-day readmissions after fast-track THA and TKA. We conducted a detailed observational study based upon prospectively collected pre-operative data and a complete 30-day follow-up on complications and re-admissions in a unselected cohort of 8804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.
RESULTS: Of 8804 procedures, 54 (0.61%) developed serious RU complications resulting in 38 (0.43%) prolonged hospitalisations and 17 (0.19%) readmissions. Acute kidney injury (AKI), defined as an increase in serum creatinine by ≥0.3 mg/dL or ≥1.5 times baseline, accounted for 43 complications (0.49%), and was most frequently associated with postoperative hypotension. Of the AKI patients, 25 (58.1%) had a preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 and 16 of these had received a NSAID postoperatively. Seven complications (0.08%) were urological, mainly hematuria after bladder catheterisation, whereas 5 (0.06%) were urosepsis/pyelonephritis.
CONCLUSIONS: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61%. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease.