Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality

Year 2019, Volume: 52 Issue: 2, 167 - 173, 31.07.2019

Selma Alagöz

Abstract

Abstract

 

Purpose: Acutekidney injury is a serious complication after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after hip fracture surgery and the impact of acute kidney injury on short and long-term clinical outcomes.

Material and method: A retrospective study was conducted among 238 patients who underwent hip fracture surgery between March 2012 and November 2017. At admission, clinical and biochemical parameters were measured and acute kidney injury defined according to the Acute Kidney Injury Network criteria. The effects of acute kidney injury on short and long-term mortality were investigated.

Results: Of the 238 patients, 47 (19.7%)developed acute kidney injury during hospitalization and 165 (69.3%) died with a mean follow-up of 22.1±19.9 months. Overall mortality was 38.2%, 54.2%, 61.8%, 65.1%, and 68.1% at 1, 2, 3, 4 and 5-years, respectively. The baseline serum creatinine, hemoglobin level, erythrocyte transfusion volume, chronic kidney disease and comorbidities more than onewere independent risk factors for acute kidney injury. Patients with acute kidney injury during hospitalization had significantly higher rates of short and long-term mortality than those without acute kidney injury. After multivariable adjustment, only chronic kidney disease emerged as an independent predictor for acute kidney injury, while congestive heart disease and longer preoperative hospitalization were risk factor for short-term mortality. 

Conclusion: Acute kidney injury is a frequent complication in patients undergoing hip fracture surgery and is independently associated with increased short and long-term mortality.

 

Özet

 

Amaç: Artmış morbidite ve mortaliteye yol açabilen akut böbrek hasarı, major cerrahi sonrası önemli bir komplikasyondur. Çalışmamızın amacı, kalça kırığı cerrahisi sonrası oluşan böbrek fonksiyon bozukluğu için olası risk faktörlerini ve akut böbrek hasarının kısa ve uzun dönem klinik sonuçlar üzerindeki etkilerini belirlemektir. 

Gereç ve yöntem: Mart 2012 - Kasım 2017 tarihleri arasında kalça kırığı ameliyatı geçirmiş 238 hasta, retrospektif olarak incelendi. Başvuru sırasında klinik ve biyokimyasal parametreler ölçüldü ve Acute Kidney Injury Networkkriterlerine göre akut böbrek hasarı tanımlandı. Akut böbrek hasarının kısa ve uzun süreli mortalite üzerindeki etkileri araştırıldı.

Bulgular: 238 hastanın 47'sinde (%19.7) akut böbrek hasarı gelişti ve tüm takip süresince 165 (%69.3) hasta öldü. Ortalama takip süresi 22.1 ± 19.9 aydı. Genel mortalite 1, 2, 3, 4 ve 5. yıllarda sırasıyla %38.2, %54.2, %61.8, %65.1 ve %68.1 idi. Bazal serum kreatinin, hemoglobin düzeyi, eritrosit transfüzyon hacmi, kronik böbrek hastalığı ve birden fazla komorbidite akut böbrek hasarı için bağımsız risk faktörleriydi. Hastanede yatış sırasında akut böbrek hasarı olan hastalar, akut böbrek hasarı olmayanlara göre anlamlı derecede yüksek oranda kısa ve uzun dönem mortaliteye sahipti. Çok değişkenli analize göre, yalnızca kronik böbrek hastalığı, akut böbrek hasarı için bağımsız bir risk belirleyicisi iken; konjestif kalp hastalığı ve daha uzun preoperatif yatış süresi, kısa dönem mortalite için risk faktörleri idi.

Sonuç: Kalça kırığı ameliyatı geçiren hastalarda akut böbrek hasarı sık görülen bir komplikasyondur ve  kısa ve uzun dönemde mortalite artışı ile ilişkilidir.

 

Keywords

Acute kidney injury, comorbidity, hip fracture, mortality

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