Acute kidney injury and mortality 1 year after major non-cardiac surgery

O’Connor, Michael; Hewson, Russell; Kirwan, Christopher; Ackland, Gareth L.; Pearse, Rupert M; Prowle, John R.

doi:10.1002/bjs.10498

Cited by 88 publications

(89 citation statements)

References 30 publications

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“…Patients were classified as having persistent AKI if the last postoperative serum creatinine level measured up to and including 30 days after surgery was at least 50 per cent greater than the preoperative baseline12. Major complications were defined as Clavien–Dindo grade III–V complications13, which include unplanned procedures under local or general anaesthesia, organ support in an intensive care setting, stroke or death.…”

Section: Methodsmentioning

confidence: 99%

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Collaborative¹

2018

BJS Open

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BackgroundAcute illness, existing co‐morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery.MethodsThis prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2‐week blocks over a continuous 3‐month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation.ResultsA total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30‐day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30‐day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin‐converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c‐statistic 0·65).DiscussionFollowing major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability.

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Section: Methodsmentioning

confidence: 99%

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Collaborative¹

2018

BJS Open

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“…AKI classified based on postoperative sCr increase within the first three postoperative days was a rare condition and was not related to mortality. AKI defined by KDIGO based on sCr changes within the 7 days after surgery has been shown to be related with increased mortality in orthopedic patients and in major noncardiac surgery . According to our results, it appears that patients’ preoperative kidney function has much more effect on outcome than do changes occurring during the short, rather stable and well‐monitored perioperative period.…”

Section: Discussionmentioning

confidence: 56%

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

Nikkinen

Nieminen

Alahuhta

et al. 2019

Acta Anaesthesiol Scand

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Background:The purpose of this study was to evaluate the prevalence of chronic kidney disease (CKD) and the incidence of perioperative acute kidney injury (AKI) in primary arthroplasty patients over 65 years of age. Risk factors, perioperative events and the outcome of surgery were evaluated.Methods: This retrospective, hospital register-based study consists of patients operated in 2014 in the area of Oulu, Finland. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. The incidence of AKI was evaluated based on the serum creatinine criteria of the KDIGO (Kidney Disease, Improving Global Outcomes) classification. Results:Of the 807 patients, 60.8% had mildly decreased (60-89 ml/min/1.73 m 2 ) and 13.5% moderately to severely decreased eGFR (<60 ml/min/1.73 m 2 ) preoperatively. Only 33.9% of patients with an eGFR < 60 ml/min/1.73 m 2 had a diagnosis of a kidney disease. In emergencies, 46.9% of patients with an eGFR < 60 ml/ min/1.73 m 2 were deceased at the 12-month follow-up point. The measurement of postoperative sCr was not complete (477/807) and was allocated to emergencies and older patient with more comorbidities. Of those whose postoperative sCr was available, 14 (2.9%) fulfilled AKI criteria. Most of the AKI cases had a decrease in eGFR preoperatively, a diagnosed kidney disease or diabetes mellitus.Conclusions: Impairment of kidney function was common and was related to mortality in emergency arthroplasties. Measurements of postoperative sCr were allocated to high risk patients. Preoperative kidney function, kidney disease and diabetes mellitus were important determinants for perioperative AKI.

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“…However, concerns over their safety profile after colorectal surgery persist [32]. The nephrotoxic effects of NSAIDs after non-cardiac surgery are well understood and, whilst commonly mild, are associated with 1-year postoperative mortality [17]. More recently, data from large, prospective databases have identified an association between NSAIDs and anastomotic leak, although this finding is inconsistent [15,16].…”

Section: Discussionmentioning

confidence: 97%

“…Randomized clinical trials (RCTs) of non-steroidal antiinflammatory drugs (NSAIDs) have demonstrated significant improvements in gastrointestinal recovery, probably through their anti-inflammatory and opioidsparing properties [13,14]. Although NSAIDs appear to offer effective postoperative analgesia, concerns remain over their safety, including the risk of AKI and anastomotic leak [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

2018

Colorectal Disease

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Aim The management of postoperative ileus following colorectal surgery remains controversial. It is the commonest complication after elective colorectal resection and is associated with an increased incidence of postoperative adverse events. The prevention and management of postoperative ileus remains unstandardized. This study aims to describe an international profile of gastrointestinal recovery after colorectal surgery and will assess the role of non-steroidal anti-inflammatory drugs, when used as postoperative analgesia, in expediting the return of gastrointestinal function.Methods A multicentre, student-and trainee-led, prospective cohort study will be conducted across both Europe and Australasia. Adult patients undergoing elective colorectal resection during 2-week data collection periods between January and April 2018 will be included. A site-specific questionnaire will capture compliance to Enhanced Recovery after Surgery components at participating centres. The primary outcome is time to gastrointestinal recovery, measured using a composite outcome of bowel function and oral tolerance. The impact of non-steroidal anti-inflammatory drugs on gastrointestinal recovery will be evaluated along with safety data with respect to anastomotic leak, acute kidney injury and complications within 30 days of surgery.Discussion This protocol describes the methodology of an international, observational assessment of gastrointestinal recovery after colorectal surgery. It discusses key challenges and describes how the results will impact on future investigation. The study will be conducted across a large student-and trainee-led collaborative network, with prospective quality assurance and data validation strategies.

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Acute kidney injury and mortality 1 year after major non-cardiac surgery

Abstract: Although the majority of postoperative AKI was mild, there was a strong association with risk of death in the year after surgery. Underlying decreases in serum creatinine concentration after major surgery could lead to underestimation of AKI severity and overestimation of recovery.

Cited by 88 publications

References 30 publications

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

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