Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study

Lars S Bjerregaard; Christoffer C Jørgensen; Henrik Kehlet

Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study

Lars S Bjerregaard, Christoffer C Jørgensen, Henrik Kehlet

Department of Clinical Medicine

3 Citations (Scopus)

Abstract

BACKGROUND: Overall medical complications have been reduced after fast- Track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: The aim of this paper was to describe the incidence and consequences of serious RU complications resulting in length of stay >4 days or 30-day readmissions after fast- Track THA and TKA. We conducted a detailed observational study based upon prospectively collected pre-operative data and a complete 30-day follow-up on complications and readmissions in a unselected cohort of 8804 consecutive fast- Track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications. RESULTS : Of 8804 procedures, 54 (0.61%) developed serious RU complications resulting in 38 (0.43%) prolonged hospitalisations and 17 (0.19%) readmissions. Acute kidney injury (AKI), defined as an increase in serum creatinine by ≥0.3 mg/dL or ≥1.5 times baseline, accounted for 43 complications (0.49%), and was most frequently associated with postoperative hypotension. Of the AKI patients, 25 (58.1%) had a preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 and 16 of these had received a NSAID postoperatively. Seven complications (0.08%) were urological, mainly hematuria after bladder catheterisation, whereas 5 (0.06%) were urosepsis/pyelonephritis. CONCLUSIONS: The overall incidence of serious RU complications after fast- Track THA and TKA was 0.61%. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease. (Cite this article as: Bjerregaard LS, Jørgensen CC, Kehlet H. Serious renal and urological complications in fast- Track primary total hip and knee arthroplasty: A detailed observational cohort study. Minerva Anestesiol 2016;82:767-76).

Original language	English
Journal	Minerva Anestesiologica
Volume	82
Issue number	7
Pages (from-to)	767-76
ISSN	0375-9393
Publication status	Published - Jul 2016

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Journal Article

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title = "Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study",

abstract = "BACKGROUND: Overall medical complications have been reduced after fast- Track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: The aim of this paper was to describe the incidence and consequences of serious RU complications resulting in length of stay >4 days or 30-day readmissions after fast- Track THA and TKA. We conducted a detailed observational study based upon prospectively collected pre-operative data and a complete 30-day follow-up on complications and readmissions in a unselected cohort of 8804 consecutive fast- Track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications. RESULTS : Of 8804 procedures, 54 (0.61%) developed serious RU complications resulting in 38 (0.43%) prolonged hospitalisations and 17 (0.19%) readmissions. Acute kidney injury (AKI), defined as an increase in serum creatinine by ≥0.3 mg/dL or ≥1.5 times baseline, accounted for 43 complications (0.49%), and was most frequently associated with postoperative hypotension. Of the AKI patients, 25 (58.1%) had a preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 and 16 of these had received a NSAID postoperatively. Seven complications (0.08%) were urological, mainly hematuria after bladder catheterisation, whereas 5 (0.06%) were urosepsis/pyelonephritis. CONCLUSIONS: The overall incidence of serious RU complications after fast- Track THA and TKA was 0.61%. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease. (Cite this article as: Bjerregaard LS, J{\o}rgensen CC, Kehlet H. Serious renal and urological complications in fast- Track primary total hip and knee arthroplasty: A detailed observational cohort study. Minerva Anestesiol 2016;82:767-76).",

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TY - JOUR

T1 - Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

T2 - a detailed observational cohort study

AU - Bjerregaard, Lars S

AU - Jørgensen, Christoffer C

AU - Kehlet, Henrik

PY - 2016/7

Y1 - 2016/7

N2 - BACKGROUND: Overall medical complications have been reduced after fast- Track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: The aim of this paper was to describe the incidence and consequences of serious RU complications resulting in length of stay >4 days or 30-day readmissions after fast- Track THA and TKA. We conducted a detailed observational study based upon prospectively collected pre-operative data and a complete 30-day follow-up on complications and readmissions in a unselected cohort of 8804 consecutive fast- Track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications. RESULTS : Of 8804 procedures, 54 (0.61%) developed serious RU complications resulting in 38 (0.43%) prolonged hospitalisations and 17 (0.19%) readmissions. Acute kidney injury (AKI), defined as an increase in serum creatinine by ≥0.3 mg/dL or ≥1.5 times baseline, accounted for 43 complications (0.49%), and was most frequently associated with postoperative hypotension. Of the AKI patients, 25 (58.1%) had a preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 and 16 of these had received a NSAID postoperatively. Seven complications (0.08%) were urological, mainly hematuria after bladder catheterisation, whereas 5 (0.06%) were urosepsis/pyelonephritis. CONCLUSIONS: The overall incidence of serious RU complications after fast- Track THA and TKA was 0.61%. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease. (Cite this article as: Bjerregaard LS, Jørgensen CC, Kehlet H. Serious renal and urological complications in fast- Track primary total hip and knee arthroplasty: A detailed observational cohort study. Minerva Anestesiol 2016;82:767-76).

AB - BACKGROUND: Overall medical complications have been reduced after fast- Track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: The aim of this paper was to describe the incidence and consequences of serious RU complications resulting in length of stay >4 days or 30-day readmissions after fast- Track THA and TKA. We conducted a detailed observational study based upon prospectively collected pre-operative data and a complete 30-day follow-up on complications and readmissions in a unselected cohort of 8804 consecutive fast- Track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications. RESULTS : Of 8804 procedures, 54 (0.61%) developed serious RU complications resulting in 38 (0.43%) prolonged hospitalisations and 17 (0.19%) readmissions. Acute kidney injury (AKI), defined as an increase in serum creatinine by ≥0.3 mg/dL or ≥1.5 times baseline, accounted for 43 complications (0.49%), and was most frequently associated with postoperative hypotension. Of the AKI patients, 25 (58.1%) had a preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 and 16 of these had received a NSAID postoperatively. Seven complications (0.08%) were urological, mainly hematuria after bladder catheterisation, whereas 5 (0.06%) were urosepsis/pyelonephritis. CONCLUSIONS: The overall incidence of serious RU complications after fast- Track THA and TKA was 0.61%. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease. (Cite this article as: Bjerregaard LS, Jørgensen CC, Kehlet H. Serious renal and urological complications in fast- Track primary total hip and knee arthroplasty: A detailed observational cohort study. Minerva Anestesiol 2016;82:767-76).

KW - Journal Article

M3 - Journal article

C2 - 27028450

SN - 0375-9393

VL - 82

SP - 767

EP - 776

JO - Minerva Anestesiologica

JF - Minerva Anestesiologica

IS - 7

ER -

Serious renal and urological complications in fast-track primary total hip and knee arthroplasty: a detailed observational cohort study

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