AKI is a common postoperative complication among vascular surgery patients and has a significant impact on morbidity, mortality, and cost. Preoperative risk assessment and optimal perioperative management guided by that risk assessment can minimize the consequences associated with postoperative AKI. Adherence to a standardized perioperative pathway designed to reduce risk of AKI after major vascular surgery offers a promising clinical approach to mitigate the incidence and severity of this challenging clinical problem.

Purpose Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. Recent findings Both AKI and CKD increase the risk for short and long-term mortality, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes. Even the mildest forms of AKI (RIFLE-R) and CKD (proteinuria without an observed reduction in eGFR) demonstrate worse clinical outcomes compared to patients with no AKI or CKD. Outcomes are worse even in patients who achieve full renal recovery before hospital discharge. These complications dramatically increase ICU length of stay, hospital length of stay, resource utilization, and both in-hospital and post-discharge costs, as evidenced by lower rates of discharges to home. Summary Acute and chronic kidney diseases remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.

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Background: Suboptimal triage of critically ill patients with surgical sepsis may contribute to adverse outcomes. Patients transferred to a tertiary care center after spending ≥24 hours at an outside facility were compared with patients who had early triage to a tertiary care center with the null hypothesis that management parameters and outcomes would be similar between groups.Methods: This prospective observational cohort study included 308 patients treated for surgical sepsis in a surgical intensive care unit at a tertiary care center. Patients transferred after spending more than 24 hours at an outside facility (n=69) were compared with patients who were directly admitted or transferred within 24 hours (n=239). Patient characteristics, management parameters, and outcomes were compared between groups. This study was registered at ClinicalTrials.gov ().Results: Average outside facility length of stay in the delayed transfer group was 43 hours. Delayed transfer patients had higher SOFA (7 vs. 5, p=0.003) and APACHE II scores (19 vs. 16, p=0.007) on admission. The interval between admission and source control was significantly longer in the delayed transfer group (12.1 vs. 1.0 hours, p=0.009). The incidence of nosocomial infection was significantly higher in the delayed transfer group (41% vs. 23%, p=0.005). Delayed transfer was independently associated with a 10-day increase in hospital length of stay. Delayed transfer patients were less likely to be discharged home (22% vs. 59%, p<0.001) and suffered twofold higher in-hospital mortality (14.5% vs. 7.1%, p=0.056). Conclusion:Patients with surgical sepsis who spent more than 24 hours at an outside facility prior to transfer had greater initial illness severity, longer intervals between admission and source control, and more nosocomial infections compared with patients who had early triage to a tertiary care center.