Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Aging Clin Exp Res. 2023 Nov;35(11):2729-2737. doi: 10.1007/s40520-023-02540-6. Epub 2023 Aug 30.
Postoperative acute kidney injury (AKI) is a critical issue in geriatric patients with pre-existing chronic kidney disease (CKD) undergoing orthopedic trauma surgery. The goal of this study was to investigate modifiable intraoperative risk factors for AKI.
A retrospective study was conducted on 206 geriatric patients with CKD, who underwent orthopedic trauma surgery. Several variables, including intraoperative blood loss, postoperative hypoalbuminemia, intraoperative blood pressure and long-term use of potentially nephrotoxic drugs, were analyzed.
Postoperative AKI (KIDGO) was observed in 25.2% of the patients. The 1-year mortality rate increased significantly from 26.7% to 30.8% in patients who developed AKI. Primary risk factors for AKI were blood loss (p < 0.001), postoperative hypoalbuminemia (p = 0.050), and potentially nephrotoxic drugs prior to admission (angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, diuretics, antibiotics, NSAIDs) (p = 0.003). Furthermore, the AKI stage negatively correlated with propofol dose per body weight (p = 0.001) and there was a significant association between AKI and the use of cement (p = 0.027). No significant association between intraoperative hypotension and AKI was observed in any statistical test. Femur fracture surgeries showed the greatest blood loss (524mL ± 357mL, p = 0.005), particularly intramedullary nailing at the proximal femur (598mL ± 395mL) and revision surgery (769mL ± 436mL).
In geriatric trauma patients with pre-existing CKD, intraoperative blood loss, postoperative hypoalbuminemia, and pre-admission use of potentially nephrotoxic drugs are associated with postoperative AKI. The findings highlight the necessity to mitigate intraoperative blood loss and promote ortho-geriatric co-management to reduce the incidence and subsequent mortality in this high-risk population.
术后急性肾损伤（AKI）是老年合并慢性肾脏病（CKD）患者行骨科创伤手术后的一个严重问题。本研究旨在探究可改变的术中风险因素。
回顾性分析 206 例老年 CKD 患者骨科创伤手术后发生 AKI（KIDGO）的情况。分析术中出血量、术后低白蛋白血症、术中血压和长期使用潜在肾毒性药物等变量。
25.2%的患者术后发生 AKI。发生 AKI 的患者 1 年死亡率从 26.7%显著增加到 30.8%。AKI 的主要危险因素是失血量（p<0.001）、术后低白蛋白血症（p=0.050）和入院前使用潜在肾毒性药物（血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、利尿剂、抗生素、非甾体抗炎药）（p=0.003）。此外，AKI 分期与丙泊酚按体重剂量呈负相关（p=0.001），AKI 与使用骨水泥显著相关（p=0.027）。术中低血压与 AKI 之间无统计学关联。股骨骨折手术失血量最大（524mL±357mL，p=0.005），尤其是股骨近端髓内钉（598mL±395mL）和翻修手术（769mL±436mL）。
对于老年合并 CKD 的创伤患者，术中失血、术后低白蛋白血症和入院前使用潜在肾毒性药物与术后 AKI 相关。研究结果强调了降低术中失血量和促进矫形-老年科共同管理的必要性，以降低这一高危人群的发病率和随后的死亡率。
