PMID- 35501928
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2524-7948 (Electronic)
IS  - 2524-7948 (Linking)
VI  - 4
IP  - 1
DP  - 2022 May 3
TI  - Incidence and risk factors for acute kidney injury after total joint 
      arthroplasty.
PG  - 18
LID - 10.1186/s42836-022-00120-z [doi]
LID - 18
AB  - BACKGROUND: Acute kidney injury (AKI) is one of the most common medical causes 
      for readmission following total joint arthroplasty (TJA). This study aimed to (1) 
      examine whether the incidence of AKI has changed over the past decade with the 
      adoption of modern perioperative care pathways and (2) identify the risk factors 
      and concomitant adverse events (AEs) associated with AKI. METHODS: 535,291 
      primary TJA procedures from the American College of Surgeons National Surgical 
      Quality Improvement Program from 2011 to 2018 were retrospectively reviewed. The 
      annual incidence of AKI was analyzed for significant changes over time. Matched 
      cohort analyses were performed to identify the risk factors and AEs associated 
      with AKI using multivariate logistic regression. RESULTS: The mean incidence of 
      AKI was 0.051%, which remained unchanged during the study period (P = 0.121). 
      Factors associated with AKI were diabetes (OR 1.96, P = 0.009), bilateral 
      procedure (OR 6.93, P = 0.030), lower preoperative hematocrit level (OR 1.09, 
      P = 0.015), body mass index (OR 1.04, P = 0.025), and higher preoperative BUN (OR 
      1.03, P = 0.043). AKI was associated with length of stay (LOS) > 2 days (OR 4.73, 
      P <  0.001), non-home discharge (OR 0.25, P <  0.001), 30-day readmission (OR 
      12.29, P <  0.001), and mortality (OR 130.7, P <  0.001). CONCLUSIONS: The 
      incidence of AKI has not changed over the past decade, and it remains a major 
      bundle buster resulting in greater LOS, non-home discharge, readmissions, and 
      mortality. Avoidance of bilateral TJA in patients with DM and high BMI as well as 
      preoperative optimization of anemia and BUN levels are advised.
CI  - (c) 2022. The Author(s).
FAU - Hung, Chun Wai
AU  - Hung CW
AD  - Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
FAU - Zhang, Theodore S
AU  - Zhang TS
AD  - Baylor College of Medicine, Houston, TX, USA.
FAU - Harrington, Melvyn A
AU  - Harrington MA
AD  - Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
FAU - Halawi, Mohamad J
AU  - Halawi MJ
AD  - Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA. 
      mohamad.halawi@bcm.edu.
LA  - eng
PT  - Journal Article
DEP - 20220503
PL  - England
TA  - Arthroplasty
JT  - Arthroplasty (London, England)
JID - 101773073
PMC - PMC9063071
OTO - NOTNLM
OT  - Acute kidney injury
OT  - Arthroplasty
OT  - Bundle buster
OT  - Incidence
OT  - Optimization
COIS- Chun Wai Hung and Theodore Zhang have no competing interests to disclose. Melvyn 
      Harrington receives consulting fees from Zimmer, Inc. and is a board member of 
      the J Robert Gladden Orthopaedic Society and the Arthritis Foundation Houston 
      Community Leadership Board, but none of these have a direct competing interest 
      with the current study. Mohammad Halawi has received grants from the J Robert 
      Gladden Orthopaedic Society and the Connecticut Convergence Institute for 
      Translation in Regenerative Engineering, as well as serving leadership positions 
      with the American Orthopaedic Association, the American Association of Hip and 
      Knee Surgeons, and the Journal of Bone and Joint Surgery; none of these serve as 
      a direct competing interest with the current study.
EDAT- 2022/05/04 06:00
MHDA- 2022/05/04 06:01
PMCR- 2022/05/03
CRDT- 2022/05/03 00:17
PHST- 2022/02/15 00:00 [received]
PHST- 2022/03/13 00:00 [accepted]
PHST- 2022/05/03 00:17 [entrez]
PHST- 2022/05/04 06:00 [pubmed]
PHST- 2022/05/04 06:01 [medline]
PHST- 2022/05/03 00:00 [pmc-release]
AID - 10.1186/s42836-022-00120-z [pii]
AID - 120 [pii]
AID - 10.1186/s42836-022-00120-z [doi]
PST - epublish
SO  - Arthroplasty. 2022 May 3;4(1):18. doi: 10.1186/s42836-022-00120-z.