Postoperative renal impairment is a serious complication of major surgeries that leads to increased morbidity and mortality. The objective of our study was to identify the risk factors for renal impairment following total joint arthroplasty. Among 17 938 total joint arthroplasties performed between 2000 and 2007, patients developing renal complications were identified. For performing univariate and multivariate analyses, patients with renal impairment were matched in a 1:2 ratio with control group who did not develop renal impairment. Ninety-eight (0.55%) patients developed either acute renal failure or acute renal injury. We identified the following as independent risk factors: elevated body mass index; elevated preoperative serum creatinine; and history of chronic obstructive pulmonary disease, liver disease, congestive heart failure, hypertension, and underlying heart disease. Renal impairment was significantly associated with increased duration of hospital stay and with in-hospital and 1-year all-cause mortality. In high-risk patients, preoperative optimization might be considered in an attempt to reduce the incidence of such a complication.
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