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

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.

CONCLUSION: 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.