Siddiqi Ahmed, White Peter B, Etcheson Jennifer I, George Nicole E, Gwam Chukwuweike U, Mistry Jaydev B, Patel Nirav G, Adam Hephizibah, Delanois Ronald E
Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
Department of Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.
Surg Technol Int. 2017 Dec 22;31:243-252.
Patients who develop acute kidney injury (AKI) have an increased risk for progression to chronic kidney disease, end-stage renal disease, and increased mortality. The outcomes of total knee arthroplasty (TKA) patients who develop AKI have remained controversial. The purpose of this review was to summarize and identify the current literature focused on 1) major risk factors, 2) short-term outcomes, and 3) costs associated with the development of perioperative AKI after TKA.
A literature search was performed using PubMed and Ovid to find literature relevant to AKI in TKA. All abstracts found via literature search were screened for relevancy to the study topics: (1) risk factors, (2) short-term outcomes, and (3) cost.
A total of 447 abstracts were initially identified. Irrelevant abstracts and those not in English were excluded from the study (n=336). Forty-five papers focused on risk factors associated with AKI, six papers focused on short-term outcomes, and seven discussed cost savings. Increased body mass index, metabolic syndrome, perioperative antibiotics, antihypertensive medications, and antibiotic-impregnated cement spacers are amongst the many modifiable patient and drug-induced risk factors associated with AKI after TKA. Perioperative renal injury is associated with increased inpatient and long-term mortality with increased length of stay and extended care facility discharge.
Increased length of stay and comorbidities have shown higher cost utilization and readmission rates. Inpatient and long-term complications and mortality are associated with postoperative AKI and a multidisciplinary perioperative approach is necessary to appropriately identify and, ultimately, prevent patients at higher risk for acute renal failure.
发生急性肾损伤（AKI）的患者进展为慢性肾脏病、终末期肾病的风险增加，死亡率也会升高。全膝关节置换术（TKA）患者发生AKI的结局仍存在争议。本综述的目的是总结和识别当前聚焦于以下方面的文献：1）主要危险因素；2）短期结局；3）TKA术后围手术期AKI发生相关的费用。
使用PubMed和Ovid进行文献检索，以查找与TKA中AKI相关的文献。对通过文献检索找到的所有摘要进行筛选，以确定其与研究主题（1）危险因素；（2）短期结局；（3）费用的相关性。
最初共识别出447篇摘要。将无关摘要和非英文摘要排除在研究之外（n = 336）。45篇论文聚焦于与AKI相关的危险因素，6篇论文聚焦于短期结局，7篇讨论了成本节约。体重指数增加、代谢综合征、围手术期使用抗生素、抗高血压药物以及抗生素骨水泥间隔物是TKA术后与AKI相关的众多可改变的患者和药物诱导危险因素。围手术期肾损伤与住院患者和长期死亡率增加、住院时间延长以及出院后转至长期护理机构有关。
住院时间延长和合并症显示出更高的成本利用率和再入院率。住院患者和长期并发症及死亡率与术后AKI相关，多学科围手术期方法对于适当识别并最终预防急性肾衰竭高风险患者是必要的。
