Association of postoperative albumin level following total knee arthroplasty
There has been an increasing requirement for total knee replacement arthroplasty (TKA) as a life-changing surgery. TKA is the choice of treatment in advanced stages of knee osteoarthritis. The risk factors for osteoarthritis include clustering of obesity, metabolic syndrome, and diabetes (DM) but, is also concerned with postoperative morbidity and mortality. Many patients undergoing TKA are prone to postoperative morbidity and mortality due to metabolic syndrome, although TKA is a safe surgery.
Hypoalbuminemia has been investigated to be an independent risk factor for acute kidney injury (AKI). Not much is known about the relationship between albumin level and prevalence of AKI in patients undergoing total knee arthroplasty (TKA). A study was performed to estimate the incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI after TKA. This study was a review of medical records of 1309 patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups as per the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). To analyze the risk factors for AKI, the multivariate logistic regression analysis was used.
In these two groups, a differentiation of incidence of AKI, hospital stay, and overall mortality was implemented using propensity score analysis. From total 1309 patients, 57 (4.4%) developed AKI as per Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). POD2_alb level<3.0 g/dL was related to AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001) after the propensity score analysis.
This study revealed that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and extended hospital stay in patients undergoing TKA.