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Introduction: Development of acute kidney injury (AKI) following primary total joint arthroplasty (TJA) is a potentially avoidable complication associated with negative outcomes including increased length of stay and mortality. The purpose of this study was to determine the effect of AKI on short-term outcomes and identify risk factors for developing AKI following either total hip or total knee arthroplasty. It was hypothesized that AKI has significant adverse effects on short-term outcomes metrics.

Methods: Patients undergoing primary TJA at a single hospital from 2005 to 2017 were identified and patient demographics, comorbidities, short-term outcomes, and perioperative laboratory results were recorded. AKI was defined as an increase in creatinine levels by 50% or 0.3 points. Demographics, comorbidities, and outcomes were compared between patients who developed AKI and those who did not. Multivariate regressions identified the independent effect of AKI on outcomes.

Results: In total, 814 (3.9%) of 20,800 patients developed AKI. AKI independently increased length of stay by 0.26 days (P < .001), in-hospital complication risk (odds ratio = 1.73,P < .001), and discharge to facility risk (odds ratio = 1.26, P = .012). Potentially modifiable variables including body mass index, perioperative hemoglobin levels, surgery duration, and operative fluids administered were predicative of AKI.

Discussion: AKI following TJA has significant adverse effects on outcomes including length of stay, discharge, and complications. Although many identified risk factors are nonmodifiable, maintaining adequate renal perfusion through optimizing preoperative hemoglobin, sufficient fluid resuscitation, and reducing blood loss may aid in mitigating the risk of developing AKI.