Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study

Lars Bjerregaard, Christoffer Calov Jørgensen, Henrik Kehlet, Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group, Per Kjærsgaard-Andersen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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: 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 8,804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.

RESULTS: Of 8,804 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 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 2 43 ml/min/1.73 m and 16 of these had received a NSAID postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis.

CONCLUSION: 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.

OriginalsprogEngelsk
TidsskriftMinerva Anestesiologica
Vol/bind82
Udgave nummer7
Sider (fra-til)767-776
ISSN0375-9393
StatusUdgivet - 30. mar. 2016

Fingeraftryk

Knee Replacement Arthroplasties
Hip
Cohort Studies
Kidney
Preexisting Condition Coverage
Kidney Diseases
Incidence
Pyelonephritis
Hematuria
Glomerular Filtration Rate
Length of Stay
Creatinine
Serum

Citer dette

Bjerregaard, L., Jørgensen, C. C., Kehlet, H., Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group, & Kjærsgaard-Andersen, P. (2016). Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study. Minerva Anestesiologica, 82(7), 767-776.
Bjerregaard, Lars ; Jørgensen, Christoffer Calov ; Kehlet, Henrik ; Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group ; Kjærsgaard-Andersen, Per. / Serious renal and urological complications in fast-track primary total hip and knee arthroplasty : a detailed observational cohort study. I: Minerva Anestesiologica. 2016 ; Bind 82, Nr. 7. s. 767-776.
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abstract = "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: 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 8,804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.RESULTS: Of 8,804 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 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 2 43 ml/min/1.73 m and 16 of these had received a NSAID postoperatively. Seven complications . (0.08 {\%}) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis.CONCLUSION: 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.",
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Bjerregaard, L, Jørgensen, CC, Kehlet, H, Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group & Kjærsgaard-Andersen, P 2016, 'Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study', Minerva Anestesiologica, bind 82, nr. 7, s. 767-776.

Serious renal and urological complications in fast-track primary total hip and knee arthroplasty : a detailed observational cohort study. / Bjerregaard, Lars; Jørgensen, Christoffer Calov; Kehlet, Henrik; Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group ; Kjærsgaard-Andersen, Per.

I: Minerva Anestesiologica, Bind 82, Nr. 7, 30.03.2016, s. 767-776.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

T2 - a detailed observational cohort study

AU - Bjerregaard, Lars

AU - Jørgensen, Christoffer Calov

AU - Kehlet, Henrik

AU - Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group

AU - Kjærsgaard-Andersen, Per

PY - 2016/3/30

Y1 - 2016/3/30

N2 - 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: 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 8,804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.RESULTS: Of 8,804 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 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 2 43 ml/min/1.73 m and 16 of these had received a NSAID postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis.CONCLUSION: 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.

AB - 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: 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 8,804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.RESULTS: Of 8,804 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 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 2 43 ml/min/1.73 m and 16 of these had received a NSAID postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis.CONCLUSION: 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.

KW - Complications

KW - Hip

KW - Knee

KW - Urological manifestations

UR - http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2016N07A0767#

M3 - Journal article

C2 - 27028450

VL - 82

SP - 767

EP - 776

JO - Minerva Anestesiologica

JF - Minerva Anestesiologica

SN - 0375-9393

IS - 7

ER -

Bjerregaard L, Jørgensen CC, Kehlet H, Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group, Kjærsgaard-Andersen P. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study. Minerva Anestesiologica. 2016 mar 30;82(7):767-776.