Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;35(11):2729-2737.
doi: 10.1007/s40520-023-02540-6. Epub 2023 Aug 30.

A comprehensive analysis of intraoperative factors associated with acute-on-chronic kidney injury in elderly trauma patients: blood loss as a key predictor

Leonard Lisitano  1   2 , Timon Röttinger  3 , Tyler Thorne  4 , Stefan Förch  3 , Jairo Cifuentes  3 , Kim Rau  3 , Panagiotis Daniel Vounatsos  3 , Edgar Mayr  3
Affiliations

A comprehensive analysis of intraoperative factors associated with acute-on-chronic kidney injury in elderly trauma patients: blood loss as a key predictor

Leonard Lisitano et al. Aging Clin Exp Res. 2023 Nov.

Abstract

Background: Postoperative acute kidney injury (AKI) is a critical issue in geriatric patients with pre-existing chronic kidney disease (CKD) undergoing orthopedic trauma surgery. The goal of this study was to investigate modifiable intraoperative risk factors for AKI.

Methods: A retrospective study was conducted on 206 geriatric patients with CKD, who underwent orthopedic trauma surgery. Several variables, including intraoperative blood loss, postoperative hypoalbuminemia, intraoperative blood pressure and long-term use of potentially nephrotoxic drugs, were analyzed.

Results: Postoperative AKI (KIDGO) was observed in 25.2% of the patients. The 1-year mortality rate increased significantly from 26.7% to 30.8% in patients who developed AKI. Primary risk factors for AKI were blood loss (p < 0.001), postoperative hypoalbuminemia (p = 0.050), and potentially nephrotoxic drugs prior to admission (angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, diuretics, antibiotics, NSAIDs) (p = 0.003). Furthermore, the AKI stage negatively correlated with propofol dose per body weight (p = 0.001) and there was a significant association between AKI and the use of cement (p = 0.027). No significant association between intraoperative hypotension and AKI was observed in any statistical test. Femur fracture surgeries showed the greatest blood loss (524mL ± 357mL, p = 0.005), particularly intramedullary nailing at the proximal femur (598mL ± 395mL) and revision surgery (769mL ± 436mL).

Conclusion: In geriatric trauma patients with pre-existing CKD, intraoperative blood loss, postoperative hypoalbuminemia, and pre-admission use of potentially nephrotoxic drugs are associated with postoperative AKI. The findings highlight the necessity to mitigate intraoperative blood loss and promote ortho-geriatric co-management to reduce the incidence and subsequent mortality in this high-risk population.

Keywords: Acute Kidney Injury (AKI); Chronic kidney disease (CKD); Geriatric patients; Ortho-geriatric co-management; Orthopedic trauma surgery; Postoperative complications.

PubMed Disclaimer

Conflict of interest statement

Leonard Lisitano, Timon Röttinger, Tyler Thorne, Stefan Förch, Jairo Cifuentes, Kim Rau, Panagiotis Daniel Vounatsos and Edgar Mayr declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
presents boxplots depicting blood loss in milliliters (mL) for various types of injuries
Fig. 2
Fig. 2
presents boxplots depicting blood loss in milliliters (mL) for femur fractures
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Li ZC, Pu YC, Wang J, Wang HL, Zhang YL. The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis. Bioengineered. 2021;12:1976–1985. doi: 10.1080/21655979.2021.1926200. - DOI - PMC - PubMed
    1. Hancı V, Özbilgin Ş, Başçı O, Ömür D, Boztaş N. Acute kidney injury after major orthopedic surgery: a retrospective study of frequency and related risk factors. Acta Orthop Traumatol Turc. 2022;56:289–295. doi: 10.5152/j.aott.2022.22048. - DOI - PMC - PubMed
    1. Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA. Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol. 2012;13:101. doi: 10.1186/1471-2369-13-101. - DOI - PMC - PubMed
    1. Neuerburg C, Förch S, Gleich J, et al. Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study. BMC Geriatr. 2019;19:330. doi: 10.1186/s12877-019-1289-6. - DOI - PMC - PubMed
    1. Wiedl A, Förch S, Fenwick A, Mayr E. Incidence, risk-factors and associated mortality of complications in orthogeriatric co-managed inpatients. Geriatr Orthop Surg Rehabil. 2021;12:2151459321998314. doi: 10.1177/2151459321998314. - DOI - PMC - PubMed