Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty
Nathan R Angerett1, Alexander Yevtukh2, Christopher M Ferguson2
1Department 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.
The Journal of Arthroplasty
|December 24, 2021
Summary
Implementing a perioperative renal protocol significantly reduced acute kidney injury (AKI) rates after total joint arthroplasty (TJA). This intervention improved patient outcomes and decreased the financial burden of postoperative complications in TJA patients.
Area of Science:
- Nephrology
- Orthopedic Surgery
- Healthcare Management
Background:
- Perioperative hip and knee arthroplasty complications pose significant clinical and financial challenges.
- Acute kidney injury (AKI) is a common complication following total joint arthroplasty (TJA), with incidence rates ranging from 2% to 15%.
- Limited published data exists on effective protocols to mitigate AKI post-TJA.
Purpose of the Study:
- To evaluate the impact of an institutional perioperative renal protocol on postoperative AKI rates.
- To assess the effectiveness of a new protocol in reducing AKI incidence after primary TJA.
Main Methods:
- A retrospective cohort study comparing pre- and post-intervention periods.
- Analysis of patient demographics, baseline creatinine, and postoperative creatinine values.
- AKI classification using the AKI Network criteria; multivariate analysis for statistical significance.
Main Results:
- The pre-intervention cohort (1013 patients) had an AKI rate of 6.71%.
- The post-intervention cohort (2169 patients) showed a reduced AKI rate of 4.15%.
- The protocol implementation resulted in a statistically significant reduction in AKI rates (P = .0015, OR = 0.59).
Conclusions:
- The developed perioperative renal protocol significantly decreases AKI rates following TJA.
- Reducing AKI post-TJA leads to improved patient outcomes.
- Implementing such protocols can lessen the financial impact of postoperative complications in TJA procedures.
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