Reducing Hypotension and Acute Kidney Injury in the Elective Total Joint Arthroplasty Population: A Multi-Disciplinary Approach

Abstract Background When critically analyzing our hospital system's rate of hypotension and acute kidney injury (AKI) after total joint arthroplasty, our incidence rates (14.54%, 6.02%) were much higher than our peers (7.17%, 2.03%) and national rates (2.0%, 3.3%). We present a multi-disciplinary management intervention that aimed to decrease overall complication rates. Method A multi-disciplinary team implemented a protocol at our suburban hospital to limit complication rates after joint replacement surgery. Hypotension, AKI, length of stay (LOS), re-admission rates, and mortality rates were compared before the protocol was implemented, after protocol implementation, and after protocol integration into our EMR (electronic medical record). Results In total, 1233 patients over 36 months were followed. Hypotension rates after protocol implementation into EMR (group 3) were significantly lower than rates before the protocol (group 1) ( P  = .002), with rates after protocol implementation without EMR (group 2) trending toward a significant decrease from group 1 ( P = .064). AKI rates in group 3 were significantly lower than group 1 ( P = .000) and group 2 ( P = .006). No difference was seen in hypotension rates between group 2 and 3 ( P = .792) or AKI rates between group 1 and 2 ( P = .533). Finally, no significant difference was seen between groups in LOS ( P = .560), re-admission rates ( P = .378), and mortality rates (all 0.0%). Conclusion By implementing a comprehensive electronic protocol consisting of pre-operative risk stratification, multi-disciplinary medical optimization, and an evolving post-operative management plan, significant decreases in hypotension and AKI can be seen.