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
  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 re-admissions in a unselected cohort of 8,804 consecutive fast-track THAs and TKAs. Our main outcomes were incidence, types and consequences of RU complications.
  
  
  RESULTS
  Of 8,804 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 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 2 43 ml/min/1.73 m and 16 of these had received a NSAID postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria 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.
authors.affiliation: Section for Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet Copenhagen University, Denmark - lars.stryhn.bjerregaard@regionh.dk.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Bjerregaard
authors.forename: Christoffer C
authors.initials: CC
authors.lastname: Jorgensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet