Acute kidney injury following major emergency abdominal surgery – a retrospective cohort study based on medical records data

Abstract

Background Acute Kidney Injury (AKI) is a frequent and serious postoperative complication in trauma or critically ill patients in the intensive care unit. We aimed to estimate the risk of AKI following major emergency abdominal surgery and the association between AKI and 90-day postoperative mortality. Methods In this retrospective cohort study, we included patients undergoing major emergency abdominal surgery at the Department of Surgery, Zealand University Hospital, Denmark, from 2010 to 2016. The primary outcome was the occurrence of AKI within postoperative day seven (POD7). AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO)-criteria. The risk of AKI was analysed with a multivariable logistic regression. The association between AKI and 90-day mortality was analysed with a multivariable survival analysis. Results In the cohort, 122 out of 703 (17.4%) surgical patients had AKI within POD7. Of these, 82 (67.2%) had AKI stage 1, 26 (21.3%) had AKI stage 2, and 14 (11.5%) had AKI stage 3. Fifty-eight percent of the patients who developed postoperative AKI did so within the first 24 h of surgery. Ninety-day mortality was significantly higher in patients with AKI compared with patients without AKI (41/122 (33.6%) versus 40/581 (6.9%), adjusted hazard ratio 4.45 (95% confidence interval 2.69–7.39, P < 0.0001)), and rose with increasing KDIGO stage. Pre-existing hypertension and intraoperative peritoneal contamination were independently associated with the risk of AKI. Conclusions The risk of AKI is high after major emergency abdominal surgery and is independently associated with the risk of death within 90 days of surgery.

Association of the perfusion index with postoperative acute kidney injury: a retrospective study

“…To identify predictive factors for postoperative AKI, patients were classified into two groups based on whether postoperative AKI occurred. The risk factors for postoperative AKI were examined by univariate and multivariate logistic regression analyses which included the following variables: old age (> 65 years); sex (male); higher ASA status (3,4,5); (14) obesity (body mass index [BMI] > 25 kg•m -2 ) (9, 10); medical history of hypertension, diabetes mellitus, heart disease, liver disease, neurovascular disease, or renal disease; moderate or severe anemia (hemoglobin < 11 g•dL -1 ) (18); low serum albumin (< 3.5 g•dL -1 ); anesthetic type (total intravenous anesthesia); duration of surgery (> 3 hours); transfusion (positive); liberal (> 12 mL•kg -1 •hr -1 ) or restrictive (< 4 mL•kg -1 •hr -1 ) fluid administration (19,20); emergent operation, low PPI; and hypotension (21). Multivariate logistic regression was used to calculate ORs and 95% confidence intervals (CIs) after simultaneously controlling for potential confounders.…”

Potentially modifiable risk factors of acute kidney injury after emergency abdominal surgery

“…To our knowledge, there was only one previous study reporting the risk factor of AKI after emergency abdominal surgery. 9 Hypertension and intraoperative peritoneal contamination were reported as independent risk factors of AKI.…”

“…Patients undergoing emergency abdominal surgery show a septic condition in about 40% at the time of surgery, and elderly patients have particularly poorly controlled comorbidities 5,9 . These patients also frequently present with deranged body homeostasis, signi cant physiologic insult, stress response and gastrointestinal dysfunction 10 .…”

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

“…A prospective study including 800 women that underwent hysterectomy revealed that visual inspection detected 38% of bladder injuries, whereas only 7% of ureteral injuries were diagnosed 13 . Meanwhile, randomized controlled studies have demonstrated that the use of prophylactic stents in gynecological procedures has yielded inconsistent results when it comes to reducing the likelihood of ureteral injury 11,24,25 . It may, however, minimize the diagnostic delay and potentially decrease postoperative morbidity 26 .…”