Abstract
Introduction
Acute renal dysfunction (ARD) following orthopaedic surgery is known to increase morbidity, mortality, and length of hospital stay. The aim of this study was to compare the incidence of new acute post-operative renal dysfunction between two cohorts of elective orthopaedic surgical patients receiving either cefuroxime or a combination of gentamicin and flucloxacillin as prophylactic antibiotic regimes. The study was initiated following a change in antibiotic prophylaxis within our unit from cefuroxime to gentamicin and flucloxacillin.
Method
Using a standardised data collection tool we retrospectively reviewed medical records of 238 patients who had received 1.5g of cefuroxime (TKR: n = 128; THR: n=110). This data was compared to prospectively collected data from 254 patients (TKR=117 THR=137) who had received Flucloxacillin 2g and Gentamicin (with the dose based on height). Primary outcome measure for the study was the RIFLE criteria which grades renal impairment: 0-Nil, 1-Risk, 2-Injury, 3-Renal failure.
Results
In a cohort of 238 patients who underwent arthroplasty and were administered cefuroxime, there were 4 patients (1.68%) who developed renal impairment. All 4 patients were grade 1 RIFLE (Risk) and all resolved by day 3 post-op. Of the 254 patients who received the new antibiotic regime of Flucloxacillin and Gentamicin, 24 (9.45%) had new onset renal impairment. 12 were RIFLE grade 1 (Risk), 7 RIFLE Grade 2 (Injury) and 5 were Grade 3 (Renal Failure) (p=0.0001, Fishers exact test). 7 of these patients remained in acute renal impairment between day 5 and day 7 post-op.
Discussion
Patients who received the combination of Flucloxacillin and Gentamicin had a significant increased risk of renal impairment which was also likely to be more severe and last longer. Following analysis of this study we have now reverted back to Cefuroxime for antibiotic prophylaxis.
