Identifying High-Risk Patients for Postoperative Renal Complications Following Femoral Intramedullary Fixation: A NSQIP Study.

BACKGROUND

Femoral intramedullary screw fixation is widely performed to stabilize femoral fractures. Although uncommon, postoperative acute kidney injury (AKI) and dialysis are serious complications associated with increased morbidity and mortality. This study aimed to identify predictors of AKI and postoperative dialysis following femoral intramedullary screw fixation.

METHODS

We utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients undergoing femoral intramedullary screw fixation (CPT 27506) between 2018 and 2022. Predictors examined included demographic variables, comorbidities, preoperative laboratory values, ASA class, operative duration, and anesthesia type. Univariate analyses were performed, followed by multivariate logistic regression to determine independent risk factors for AKI and postoperative dialysis. Statistical significance was set at α = 0.05.

RESULTS

A total of 63,734 patients were analyzed. Univariate predictors of AKI and postoperative dialysis included renal failure, elevated blood urea nitrogen, general anesthesia, hypertension, male sex, advanced age, decreased hematocrit, higher ASA class, diabetes, elevated BMI, and longer operative time. Multivariate logistic regression identified the following independent predictors: pre-existing renal insufficiency (p < 0.0001), elevated blood urea nitrogen (p < 0.0001), use of general anesthesia (p < 0.001), hypertension (p < 0.0001), male sex (p < 0.0001), older age (p < 0.001), decreased hematocrit (p < 0.001), ASA class III and IV (p = 0.0013, p = 0.0229), diabetes (p = 0.0038), and increased BMI (p = 0.0043).

CONCLUSION

This study identifies significant independent predictors of AKI and postoperative dialysis in patients undergoing femoral intramedullary screw fixation. Preoperative risk stratification incorporating these factors may improve perioperative planning and reduce adverse renal outcomes.