Department of Special Surgery- Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan.
Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
J Orthop Sci. 2020 Nov;25(6):1029-1034. doi: 10.1016/j.jos.2019.12.007. Epub 2020 Jan 31.
Total joint replacement (TJR) is a commonly performed procedure worldwide, and postoperative acute kidney injury (AKI) is one of the complications that determine the overall prognosis in various surgical settings. We aimed to identify the risk of AKI after TJR (primary and revision) and determine the factors associated with postoperative AKI.
We performed a retrospective study of 1068 patients (>18 years) who underwent TJR between 2014 and 2019 at a tertiary medical center. Patients' demographic, clinical, and laboratory data were reviewed.
A total of 1068 patients were included in this study [mean age, 60.5 ± 13 years; 260 men (24.3%); 808 women (75.7%)]. A total of 962 patients (90.1%) underwent primary joint replacement (PJR) and 106 underwent joint revision (9.9%). Sixty-six patients (6.2%) had postoperative AKI. Primary total hip replacement patients had a lower risk of AKI than patients with other types of TJR (3.0%; p = 0.024). The factors associated with AKI (adjusting for known confounders) included male gender [adjusted odds ratio (AOR): 1.751; 95% confidence interval (CI): 1.01-3.03; p = 0.046], diabetes mellitus (DM) [AOR: 2.806; 95% CI: 1.687-5.023; p ≤ 0.001], hypertension (HTN) [AOR: 1.751; 95% CI: 1.159-3.442; p = 0.013], and the use of vancomycin as a prophylactic antibiotic [AOR: 1.691; 95% CI: 1.1-2.913; p = 0.050]. Chronic kidney disease (CKD) [AOR: 1.00; 95% CI: 0.432-2.27; p = 0.981] was not found to be a significant risk factor.
In this study, the risk of preoperative AKI in patients who underwent TJR was 6.2%. Male gender, preoperative comorbidities such as DM and HTN, and preoperative use of vancomycin were associated with increased risk of postoperative AKI.
全关节置换术（TJR）是一种在全球范围内广泛实施的手术，术后急性肾损伤（AKI）是影响各种手术预后的并发症之一。本研究旨在确定 TJR（初次和翻修）术后发生 AKI 的风险，并确定与术后 AKI 相关的因素。
我们对 2014 年至 2019 年在一家三级医疗中心接受 TJR 的 1068 例（>18 岁）患者进行了回顾性研究。回顾了患者的人口统计学、临床和实验室数据。
本研究共纳入 1068 例患者[平均年龄 60.5±13 岁；260 例男性（24.3%）；808 例女性（75.7%）]。962 例（90.1%）患者行初次关节置换术（PJR），106 例患者行关节翻修术（9.9%）。66 例（6.2%）患者术后发生 AKI。初次全髋关节置换术患者发生 AKI 的风险低于其他类型 TJR 患者（3.0%；p=0.024）。与 AKI 相关的因素（调整已知混杂因素后）包括男性[校正比值比（AOR）：1.751；95%置信区间（CI）：1.01-3.03；p=0.046]、糖尿病（DM）[AOR：2.806；95% CI：1.687-5.023；p≤0.001]、高血压（HTN）[AOR：1.751；95% CI：1.159-3.442；p=0.013]和万古霉素作为预防性抗生素的使用[AOR：1.691；95% CI：1.1-2.913；p=0.050]。慢性肾脏病（CKD）[AOR：1.00；95% CI：0.432-2.27；p=0.981]不是显著的风险因素。
在本研究中，TJR 患者术前 AKI 的风险为 6.2%。男性、术前合并症如糖尿病和高血压以及术前万古霉素的使用与术后 AKI 风险增加相关。
