Incidence and Risk Factors of in-hospital mortality from AKI after non-cardiovascular operation: A nationwide Survey in China

Abstract

This study aimed to describe the mortality and risk factors of in-hospital mortality from acute kidney injury (AKI) after non-cardiovascular operation in China based on a nationwide survey about AKI. The study sample was drawn from ISN AKF 0by25 China Consortiums, which is a nationwide, cross-sectional survey from 22 provinces in mainland China. AKI after non-cardiovascular operation was identified according to the 2012 KDIGO AKI creatinine criteria or expanded criteria. In total, 3468 cases were identified as hospital-acquired AKI (HA-AKI). Of these, 1059 cases were defined as AKI after major non-cardiovascular surgery. Post-operative AKI and non-operative AKI were similar in aetiology and in the need for RRT intervention. The all-cause in-hospital mortality was 17.0% (180 of 1059) among patients with AKI after a major surgery. Older age (OR = 1.14, p = 0.046), more severe comorbidities (OR = 9.29, p < 0.001), a history of CVD (OR = 1.85, p = 0.007), more severe peak AKI stage, and being located in the northwest region of China (OR = 2.47, p = 0.012) were all significantly associated with increased in-hospital mortality risk in AKI patients who underwent an operation. AKI after a non-cardiovascular operation has become a huge medical burden in China. The features of operative AKI varied substantially in different regions of China. Increased attention must be paid to the occurrence of potential intrinsic renal AKI when patients are exposed to nephrotoxic factors or comorbidities.

Comparison of Postoperative Acute Kidney Injury Between Laparoscopic and Laparotomy Procedures in Elderly Patients Undergoing Colorectal Surgery

“…10,11 Perioperative hemodynamic fluctuations due to surgical stress, blood loss, or bereaved vascular elasticity, will disturb renal perfusion pressure, and further have a fatal impact on renal function, thereby causing postoperative AKI. [20][21][22] LSP is known for minimal trauma, less blood loss, and more stable hemodynamics, especially in elderly patients. Our findings suggest that the application of LSP in elderly patients may be beneficial to elderly patients' renal function compared with LTP, maybe by hemodynamic stabilization thereby decreasing vasoactive agent demands, especially vasoconstrictors such as metaraminol.…”

Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction

“…15 Postoperative AKI is associated with increased risk of various short-and long-term complications, but whether AKI mediates the risk remains unclear. 19 Similarly, patients with postoperative AKI appear to have increased mortality, [20][21][22][23][24][25] but this evidence relies on various definitions of AKI, usually considering advanced and severe renal injury.…”

Aligning Patient Acuity With Resource Intensity After Major Surgery

“…The authors note that readmission to the index hospital may represent a surrogate for geographic location, access to health care resources, and care fragmentation in which data and knowledge regarding the patient's care are not shared between institutions. These variables have known, significant effects on patient outcomes 24 . Finally, readmission to a different hospital that is closer to home often equates to receiving care at a low-volume hospital; a risk factor for postoperative mortality (relative risk 1.20 vs the top volume quartile of hospitals), as identified by Forte et al 26 Therefore, continuously resampled physiologic variables and careful interpretation of hospital and health care delivery factors have the potential to optimize patient mortality predictions and acuity assessments after major surgery.…”