Advertisement
Advertise here Publish your press releases here Sponsor BioPortfolio
Follow us on Twitter Sign up for daily news and research emails Contributors wanted

Chronic Kidney Disease and Postoperative Morbidity After Elective Orthopedic Surgery.

05:16 EDT 23rd April 2014 | BioPortfolio

Summary of "Chronic Kidney Disease and Postoperative Morbidity After Elective Orthopedic Surgery."

Background: Reduced estimated glomerular filtration rate (eGFR) is strongly associated with increased cardiovascular risk and all-cause mortality. Associations with morbidity in elective, moderate-risk noncardiac surgery have not been explored. We hypothesized that chronic kidney disease (CKD) would be associated with excess morbidity after elective, moderate-risk orthopedic surgery. Methods: Patients undergoing elective orthopedic joint replacement procedures were studied, representing a large proportion of global surgical procedures and characterized by highly homogeneous anesthetic and surgical practice. eGFR was calculated from routine creatinine measurements using the Modification of Diet in Renal Disease equation. CKD was defined as eGFR <60 mL/min/1.73 m(2). Cardiac risk (Revised Cardiac Risk Index) and evidence-based, perioperative factors associated with perioperative morbidity (operative time, blood loss, perioperative temperature) were also recorded prospectively. The primary end point was postoperative morbidity, recorded prospectively using the postoperative morbidity survey. Morbidity differences were analyzed between patients with CKD and normal preoperative renal function (chi(2) test for trend) and presented as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CIs). The secondary end points were time to hospital discharge and time to become morbidity free (analyzed by log-rank test), both between and within CKD compared with normal renal function patients. Multiple regression analysis was performed to assess the association of CKD, perioperative factors with morbidity, and length of hospital stay. Results: Postoperative morbidity survey was recorded in 526 patients undergoing elective orthopedic surgery. CKD patients (n = 142; 27%) sustained excess morbidity on postoperative day 5 (OR 2.1 [95%
CI:
1.2-3.7]; P < 0.0001). CKD patients took longer (HR 1.6 [95%
CI:
1.2-1.9]) to become morbidity free (log-rank test, P < 0.0001). Time to hospital discharge was delayed by 4 days in CKD patients (HR 1.4 [95%
CI:
1.2-1.7]; P = 0.0001; log-rank test). CKD patients sustained more pulmonary (OR 2.2 [95%
CI:
1.3-3.6]; P = 0.002), infectious (OR 1.7 [95%
CI:
1.1-2.7]; P = 0.01), cardiovascular (OR 2.4 [95%
CI:
1.2-4.8]; P = 0.01), renal (OR 2.3 [95%
CI:
1.5-3.5]; P < 0.00,001), neurological (OR 4.3 [95%
CI:
1.3-17.7]; P = 0.005), and pain (OR 1.8 [95%
CI:
1.03-3.1]; P = 0.04) morbidities. Further stratification of CKD revealed preoperative eGFR

Affiliation

From the *Department of Medicine, Wolfson Institute for Biomedical Research, University College London;

Journal Details

This article was published in the following journal.

Name: Anesthesia and analgesia
ISSN: 1526-7598
Pages:

Links

PubMed Articles [18936 Associated PubMed Articles listed on BioPortfolio]

The Oxford Renal (OxRen) cross-sectional study of chronic kidney disease in the UK.

Chronic kidney disease (CKD) diagnosed with objective measures of kidney damage and function has been recognised as a major public health burden. Independent of age, sex, ethnicity and comorbidity, st...

Dermatological diseases in patients with chronic kidney disease.

Context: There are a variety of dermatological diseases that are more commonly seen in patients with chronic kidney disease (CKD) and renal transplants than the general population. Evidence Acquisitio...

An Update on Coronary Artery Disease and Chronic Kidney Disease.

Despite the improvements in diagnostic tools and medical applications, cardiovascular diseases (CVD), especially coronary artery disease (CAD), remain the most common cause of morbidity and mortality...

Vaccination issues in patients with chronic kidney disease.

Infections are an important cause of morbidity and mortality among patients at all stages of chronic kidney disease. Prevention through vaccination remains the best strategy to minimize the adverse co...

Perioperative fluid therapy for surgical patients with chronic kidney disease.

Chronic kidney disease (CKD) often accompanies cardiovascular complications, causing postoperative morbidity and even mortality. Since fluid and electrolyte homeostasis is deregulated in CKD patients,...

Clinical Trials [7035 Associated Clinical Trials listed on BioPortfolio]

Efficacy and Safety of IV Diclofenac (DIV075V)for Pain After Elective Orthopedic Surgery

This study will compare repeated intermittent IV dosing of diclofenac in patient with moderate to severe post-surgical pain from elective orthopedic surgery.

Efficacy and Safety of Intranasal Morphine for Pain After Elective Orthopedic Surgery

Multiple-center, multiple-dose, randomized, double-blind, six-arm, active- and placebo-controlled study in patients with moderate to severe post-surgical pain from elective orthopedic surg...

The PRIMO Study-Paricalcitol Capsules Benefits in Renal Failure Induced Cardiac Morbidity in Chronic Kidney Disease Stage 3/4

To investigate the effects of paricalcitol capsules on changes on cardiac structure and function in subjects with Stage 3/4 Chronic Kidney Disease who have left ventricular hypertrophy

Perioperative Depression and Postoperative Arrhythmia in Elective Coronary Bypass Graft Surgery

Postoperative arrhythmias (heart irregularities) are one of the most common complications after cardiac surgery and are associated with increased morbidity and mortality. Preoperative depr...

How Lidocaine Affects Outcomes In Orthopedic Surgery Patients

This study will evaluate the effect of intraoperative lidocaine infusion on postoperative orientation and concentration in elderly patients having general anesthesia for orthopedic surgeri...

Medical and Biotech [MESH] Definitions

Conditions in which the KIDNEYS perform below the normal level for more than three months. Chronic kidney insufficiency is classified by five stages according to the decline in GLOMERULAR FILTRATION RATE and the degree of kidney damage (as measured by the level of PROTEINURIA). The most severe form is the end-stage renal disease (CHRONIC KIDNEY FAILURE). (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002)

The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.

Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.

Abnormal enlargement or swelling of a KIDNEY due to dilation of the KIDNEY CALICES and the KIDNEY PELVIS. It is often associated with obstruction of the URETER or chronic kidney diseases that prevents normal drainage of urine into the URINARY BLADDER.

A severe irreversible decline in the ability of kidneys to remove wastes, concentrate URINE, and maintain ELECTROLYTE BALANCE; BLOOD PRESSURE; and CALCIUM metabolism. Renal failure, either acute (KIDNEY FAILURE, ACUTE) or chronic (KIDNEY FAILURE, CHRONIC), requires HEMODIALYSIS.

Search BioPortfolio: