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Failure to Rescue After Severe Acute Kidney Injury in Patients Undergoing Non-Cardiac Surgery
Kunal Karamchandani1, Brittany J McDowell2, Karthik Raghunathan3
1Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
The Journal of Surgical Research
|July 1, 2022
Summary
Failure to rescue after severe acute kidney injury (AKI) leads to significant mortality in surgical patients. Advanced age, cancer, and septic shock are key risk factors, highlighting the need for targeted interventions to improve surgical quality and patient outcomes.
Area of Science:
- Surgical Quality Improvement
- Nephrology
- Critical Care Medicine
Background:
- Failure to rescue (FTR) is a critical indicator of surgical quality, often linked to preventable deaths following postoperative complications.
- Acute kidney injury (AKI) is a common and severe postoperative complication associated with high mortality rates.
Purpose of the Study:
- To identify perioperative risk factors associated with failure to rescue in patients who develop severe postoperative AKI.
- To enhance understanding of patient and surgical factors contributing to mortality after AKI.
Main Methods:
- Analysis of adult patients undergoing non-cardiac surgery from 2012-2018 using the American College of Surgeons National Surgical Quality Improvement Program database.
- Identification of severe AKI defined by creatinine increase or need for hemodialysis.
- Multivariable logistic regression to determine risk factors for failure to rescue in AKI patients.
Main Results:
- Over 5.7 million patients were analyzed, with 0.46% developing severe AKI, and 25.6% of those experiencing failure to rescue.
- Strong risk factors for failure to rescue in AKI patients included advanced age, higher ASA class, preoperative ascites, disseminated cancer, septic shock, and recent blood transfusion.
- These factors significantly increased the odds of mortality in patients with severe AKI.
Conclusions:
- Approximately one-fourth of patients with severe AKI after non-cardiac surgery die within 30 days.
- Both patient-specific and surgery-related factors contribute to failure to rescue.
- Further research is crucial to develop early interventions for high-risk AKI patients to reduce mortality.
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