Impact of postoperative acute kidney injury in patients undergoing major gastrointestinal surgery on 1-year survival and renal outcomes: a national multicentre cohort study

Abstract

Background The intermediate-term impact of acute kidney injury (AKI) in patients after major gastrointestinal and liver surgery has not been well characterized. This study aimed to evaluate the 1-year mortality rate and renal outcomes associated with postoperative AKI in a national prospective cohort. Methods This prospective multicentre, observational cohort with 1-year postoperative follow-up included adults undergoing major gastrointestinal and liver surgery across the UK and Ireland between 23 September and 18 November 2015. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was death at 1-year after surgery, and the secondary outcome was Major Adverse Kidney Events (MAKE-365). Cox proportionate and multilevel logistic regression were used to account for case mix. Results Of 5745 patients across 173 centres, 1-year follow-up data was completed for 3504 patients (62.2 per cent, 126 centres), with attrition largely explained by centre non-participation (63.1 per cent). Some 13.6 per cent (475 of 3504) patients developed AKI by 7 days after surgery (stage 1: 9.2 per cent; stage 2/3: 4.3 per cent). At 1 year, 10.8 per cent (378 patients) experienced a MAKE-365 endpoint (303 patients had died, 61 had renal replacement therapy and 78 had renal dysfunction). Patients who experienced AKI by 7 days after surgery had a higher hazard of death at 1 year for KDIGO stage 1 (hazard ratio 1.50 (95 per cent c.i. 1.08 to 2.08), P = 0.016) and KDIGO stage 2/3 (hazard ratio 2.96 (95 per cent c.i. 2.02 to 4.33), P < 0.001). Both KDIGO stage 1 (odds ratio 2.09 (95 per cent c.i. 1.50 to 2.92), P < 0.001) and stage 2/3 (odds ratio 9.26 (95 per cent c.i. 6.31 to 13.59), P < 0.001) AKI were independently associated with MAKE-365. Conclusion AKI events within 7 days after gastrointestinal or liver surgery are associated with significantly worse survival and renal outcomes at 1 year.

Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data

“…Whilst our study is unable to establish a causal relationship between complications and long-term healthcare use given the potential for unmeasured confounding, it adds to the substantial literature demonstrating the poor long-term health outcomes associated with postoperative complications. 8 12 , 13 , 14 27 Our data highlight the attention provided in primary care before and after surgery. Whilst the largest relative change in healthcare encounters was within secondary care, primary care still accounted for most encounters, even amongst patients with complications.…”

“… 4 5 Less frequent and more serious complications include myocardial infarction and acute kidney injury. 6 , 7 , 8 , 9 , 10 Patients with complications after surgery have a greatly increased risk of death during their hospitalisation. 3 However, even those who survive the immediate affects of the complication have substantially reduced long-term survival.…”

“… 3 However, even those who survive the immediate affects of the complication have substantially reduced long-term survival. 8 11 12 In addition, patients with complications have greater healthcare costs and longer lengths of hospital stay. 13 14 Given the increased length of stay associated with complications, it is likely that healthcare use is elevated.…”

Preoperative geriatric nutritional risk index and neutrophil-to-lymphocyte ratio relate to postoperative acute kidney injury in elderly patients undergoing laparoscopic abdominal surgery

“…Elderly individuals, especially when affected by comorbid conditions, are more prone to developing AKI ( 20 ). Factors such as infections, heart failure, hypertension, gastrointestinal bleeding, surgical procedures, and urologic stones are predisposing elements that can easily induce AKI ( 21 , 22 ). Therefore, early diagnosis and intervention hold paramount significance in preventing postoperative AKI in elderly patients undergoing abdominal surgeries, with far-reaching implications for reducing societal and family healthcare expenditures.…”

Preoperative urine neutrophil gelatinase‐associated lipocalin predicts mortality in colorectal cancer patients after laparoscopic surgery: A single‐center study

“…Postoperative AKI is associated with CKD progression and increased late mortality after cardiac and other organ surgery 42. The STARSurg Collaborative43 recently confirmed that postoperative AKI in patients undergoing gastrointestinal surgery increased mortality after 1 year of observation. The role of AKI in the causal relationship with mortality has not been established.…”