title: Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib.
abstract: Safe and effective perioperative analgesia is instrumental to patient satisfaction and decreasing LOS after TJA. We evaluated rates of acute kidney injury (AKI) in primary and revision TJA using a multimodal pain control regimen including scheduled celecoxib and PRN ketorolac. Postoperative AKI was identified in 43/903 (4.8%) of 903 of patients with adequate preoperative renal function. Those who developed AKI had significantly increased LOS (P < .01), were older, more obese, and more likely to have diabetes (P < .05). With a protocol incorporating NSAIDs in patients without evidence of preoperative renal impairment, there is a 4.8% rate of AKI, which is 2.7 times higher than the reported literature. Acute postoperative kidney injury was significantly correlated with increased LOS and has important patient safety and healthcare-related cost implications.
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Lucian C
authors.initials: LC
authors.lastname: Warth
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Hogue
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Klaassen
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Steve S
authors.initials: SS
authors.lastname: Liu
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D000068579:Celecoxib / Q000009:adverse effects*; D015331:Cohort Studies; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D007596:Joints / Q000601:surgery; D020910:Ketorolac / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D059408:Pain Management; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000068579:Celecoxib; D020910:Ketorolac
keywords: acute kidney injury; nonsteroidal anti-inflammatories; pain control; total hip arthroplasty; total knee arthroplasty