Cirrhotic Patients With Acute Kidney Injury (Aki) Have Higher Mortality After Abdominal Hernia Surgery

Abstract

Background: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). Aim: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. Methods: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . Results: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. Conclusions: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.

Early Incisional Hernia After Liver Transplantation: Risk Factors and Hernia Repair Results

“…Patients with chronic liver disease often exhibit protein-energy malnutrition due to hypermetabolism and malabsorption. Furthermore, ascites, often present as a consequence of portal hypertension, increases intra-abdominal pressure and contributes to abdominal muscle weakness 5 , 12 .…”

Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital: Risk assessment and survival analysis

“…In these patients, the presence of ascites is associated with poor quality of life, increased risk of spontaneous abdominal infections and renal failure. [8] For these reasons, in addition to the supposed perioperative decompensation, the repair of hernias in the abdominal and inguinal wall in these patients is traditionally managed by a “watch and see strategy.” [5,8–12] However, this strategy can lead to worse outcomes for the patient in inadequate clinical conditions, such as in emergency cases, where an increased risk of perioperative morbidity and mortality is frequently found. [13–15]…”

“…is traditionally managed by a "watch and see strategy." [5,[8][9][10][11][12] However, this strategy can lead to worse outcomes for the patient in inadequate clinical conditions, such as in emergency cases, where an increased risk of perioperative morbidity and mortality is frequently found. [13][14][15] Thus, there is a vast literature on patients with cirrhosis evaluating hernia repair that shows a wide range of morbidity and mortality rates.…”