Acute kidney injury post‐major orthopaedic surgery: A single‐Centre case–control study

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Excerpt

Acute kidney injury (AKI) is a common problem after major orthopaedic surgery (MOS) given the ageing population and leads to an increased burden of long‐term morbidity and mortality. With ageing, the kidney undergoes a physiological decline in renal mass and along with the presence of multiple complex comorbidities, the risk of AKI is heightened. Recovery of kidney function after AKI in the elderly is less likely to occur when the patient is older than 65 years.1 Although perceived to be reversible, even small changes in serum creatinine (SCr) during hospitalization increased short‐term mortality.2 Furthermore, the risk of long‐term mortality was three‐fold greater in patients with moderate and severe AKI compared with patients without AKI..3
There are a handful of studies looking at risk factors associated with AKI post‐MOS.4 Previous studies have found an incidence of around 9%6 with an increased risk during emergency procedures.4 For patients undergoing non‐cardiac surgery with prior normal renal function, the incidence less than 1%11 recognized risk factors of AKI include age, chronic kidney disease (CKD), medications such as angiotensin converting enzyme inhibitor (ACE‐I) or angiotensin receptor blockers (ARB), diuretics and a history of diabetes, hypertension and obesity. Less understood is the association between non‐steroidal anti‐inflammatory drugs (NSAID) administration and the risk of AKI. At our institution, parenteral parecoxib, a NSAID that inhibits the enzyme cyclo‐oxygenase 2 was often administered to patients with an estimated glomerular filtration (eGFR) rate of greater than 60 mL/min during MOS. Given the long‐term morbidity and mortality associated with AKI, the aim of the study was to look at factors that were associated with AKI in the context of orthopaedic surgery at our institution.
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