Acute kidney injury following enhanced recovery for orthopaedic joint replacement surgery —role of preoperative kidney disease?

Editor —Enhanced recovery after surgery (ERAS), a multifaceted approach to anaesthesia and surgery, has been implemented widely throughout orthopaedic lower limb arthroplasty.1 The aim is to discontinue i.v. fluids by midday on postoperative day one;2 however, there is marked variation in practice between centres. We sought to determine the incidence of acute kidney injury (AKI) in patients undergoing hip or knee arthroplasty under ERAS principles particular to our unit, where fluids are discontinued before leaving the recovery room. All patients who had undergone primary unilateral lower limb arthroplasty as part of an ERAS programme over a three month period were analysed retrospectively. Patients received cefuroxime as antibiotic prophylaxis or clarithromycin if history of penicillin allergy. Dalteparin or fondaparinux was given for venothromboembolic prophylaxis based on consultant preference. Unfractionated heparin (mini-hep) was used for estimated glomerular filtration rate (eGFR)<45 ml min−1. Multimodal analgesia including paracetamol, gabapentin and modified release morphine was given perioperatively with dosing adjusted for patient weight, renal function and preoperative medications. Diagnosis of AKI was based on the modified acute kidney injury network (AKIN) criteria as described by National Institute for Health and Care Excellence (NICE) Guidelines:3 rise in creatinine of 26 mmol litre−1 or greater within 48 h or a 50% or more rise in creatinine known or ...
Source: British Journal of Anaesthesia - Category: Anesthesiology Source Type: research