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Hip replacements may not be the best choice for acute kidney injury patients, shows a new study that highlights above normal rates of death, longer hospital stays, revisions, transfusions, implant problems, above norm hospital charges; and, discharge to rehab hospitals.
Post-surgical acute kidney injury following total hip arthroplasty results in increased rates of complications, including death, say researchers recently writing in Arthritis Research & Therapy.
The reported incidence of acute kidney injury, which is a risk factor for the development of chronic kidney disease and higher mortality, varies from 1 to 8 percent following hip or knee arthroplasty, according to single-center studies with small population samples. In a national U.S. sample, the incidence of acute kidney injury in people who underwent knee or hip arthroplasty with an underlying diagnosis of osteoarthritis was 1.3 percent, but no estimates of acute kidney injury post-total hip arthroplasty or associated complications, such as infection, were available.
“In the absence of studies of incidence, correlates, and outcomes of acute kidney injury post-total hip arthroplasty in the U.S. with representative samples, our objective was to examine these aspects,” wrote the authors, led by Jasvinder A. Singh, M.D., of the University of Alabama at Birmingham.
This retrospective cohort study included 4.1 million total hip arthroplasties recorded in the U.S. National Inpatient Sample from 1998 to 2014. During the primary hospital admission, the rate of acute kidney injury events was 1.5 percent. Study outcomes included post-surgical complications, infection, revision, transfusion, or death, along with healthcare utilization.
After adjusting for age, gender, race, income, underlying diagnosis, medical comorbidity, and the insurance payer, acute kidney injury in people who underwent primary total hip arthroplasty was associated with significantly higher rates of death (odds ratio 8.52); hospital stay longer thean three days (odds ratio 4.34); revision surgies (odds ratio 2.54); transfusion (odds ratio 2.46); implant infection (odds ratio 2.34); total hospital charges above the median (odds ratio 2.29); and discharge to a rehabilitation facility (odds ratio 2.11).
“Patient education, careful avoidance of nephrotoxic medications in peri-operative including those leading to hypotension, maintenance of adequate intravascular volume, and effective comorbidity management (cardiac, vascular, pulmonary, renal, diabetes, etc.) may also help in reducing the risk of post- total hip arthroplasty acute kidney injury,” the authors wrote.
Initiatives that further improve the care pathways for patients undergoing total hip arthroplasty may also reduce excess healthcare utilization, the authors wrote, and suggested further study to “examine interventions that target modifiable risk factors for acute kidney injury.”
Jasvinder A. Singh, John D. Cleveland. “Acute kidney injury after primary total hip arthroplasty: a risk multiplier for complication, mortality, and healthcare utilization.”Arthritis Research & Therapy.
February 19, 2020. DOI: https://doi.org/10.1186/s13075-020-2116-3