Ulucay Cagatay, Eren Zehra, Kaspar Elif Cigdem, Ozler Turhan, Yuksel Korcan, Kantarci Gulcin, Altintas Faik
Orthopaedics and Traumatology Department, Yeditepe Medical Faculty, Ankara Cad no 102 Kozyatagi Istanbul PK, Turkey.
Geriatr Orthop Surg Rehabil. 2012 Dec;3(4):150-6. doi: 10.1177/2151458512473827.
We aimed to evaluate possible risk factors assocıated wıth acute kidney injury (AKI) after hip fracture surgery in the elderly individuals.
Level II diagnostic study, evidence obtained from prospective cohort study from 1 center with level 2, and 3 patients.
A total of 165 patients (>65 years) with femoral neck fracture were enrolled in this prospective study between 2007 and 2010. Two patients were dropped for inadequate laboratory follow-up data. Patients with kidney failure or renal replacement therapy (RRT) history or AKI at admission were excluded.
Nephrology consultation was obtained from all patients at admission. All patients had undergone bipolar cemented hip arthroplasty that was performed by the same surgical team in all patients within 24 hours of fracture and admission under the same protocol.
Serum creatinine (SCr), urine output, and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Acute Kidney Injury Network classification. Hospital charges were converted from Turkish Liras to US dollars and rounded.
Among 163 patients, AKI occurred in 25 (15.3%) patients, all within the first 48 postoperative hours. Three (1.8%) patients required RRT. Baseline SCr levels were restored within 4.84 ± 1.34 days on average (3-8 days). No patient required RRT after discharge. The mean hospital stay was 3 days (2-6 days) longer and the hospital charge was 2500 US$ higher for the patients with AKI. After multivariable adjustment, only lower estimated glomerular filtration rate levels (odds ratio 0.945, 95%confidence interval 0.92-0.96) emerged as an independent predictor for AKI.
The AKI represents a frequent complication after hip fracture surgery associated with longer hospital stay and higher treatment costs with increased morbidity. Our results show baseline renal function is an independent predictor of AKI.
我们旨在评估老年患者髋部骨折手术后与急性肾损伤（AKI）相关的可能危险因素。
二级诊断研究，证据来自一个中心的前瞻性队列研究，有2级和3级患者。
2007年至2010年期间，共有165例（>65岁）股骨颈骨折患者纳入这项前瞻性研究。2例患者因实验室随访数据不足而被剔除。排除入院时患有肾衰竭或接受过肾脏替代治疗（RRT）病史或AKI的患者。
所有患者入院时均接受了肾脏科会诊。所有患者均接受了双极骨水泥型髋关节置换术，由同一手术团队在骨折后24小时内对所有患者进行手术，并按照相同方案入院治疗。
在基线时以及此后每天评估血清肌酐（SCr）、尿量和全血细胞计数。AKI根据急性肾损伤网络分类进行定义。医院费用从土耳其里拉换算为美元并四舍五入。
在163例患者中，25例（15.3%）患者发生了AKI，均在术后48小时内。3例（1.8%）患者需要RRT。基线SCr水平平均在4.84±1.34天内恢复（3 - 8天）。出院后无患者需要RRT。AKI患者的平均住院时间长3天（2 - 6天），医院费用高2500美元。多变量调整后，只有较低的估计肾小球滤过率水平（比值比0.945，95%置信区间0.92 - 0.96）成为AKI的独立预测因素。
AKI是髋部骨折手术后常见的并发症，与住院时间延长、治疗费用增加以及发病率上升相关。我们的结果表明基线肾功能是AKI的独立预测因素。
