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Risk factors for postoperative acute kidney injury after major abdominal surgery

Marija Milinkovic, Zeljko Lausevic, Milica Kravljaca

    Clinical Nephrology
    |December 29, 2023
    PubMed
    Abstract

    Insights

    Acute kidney injury (AKI) after major abdominal surgery (MAS) affects 16.5% of patients. Key risk factors include blood transfusions, pneumonia, and vasoactive drug use, significantly increasing mortality risk.

    Area of Science:

    • Nephrology
    • Surgical Outcomes
    • Critical Care Medicine

    Background:

    • Acute kidney injury (AKI) is a common complication in hospitalized patients, significantly impacting outcomes.
    • While AKI after cardiac surgery is well-studied, AKI following major abdominal surgery (MAS) receives less attention.
    • Developing predictive models for AKI after MAS is crucial for improving patient care.

    Purpose of the Study:

    • To determine the incidence of AKI in patients undergoing MAS.
    • To identify independent risk factors associated with postoperative AKI after MAS.
    • To evaluate the intrahospital outcomes, including mortality, for patients who develop AKI post-MAS.

    Main Methods:

    • A retrospective study of 200 adult patients who underwent MAS.
    • Exclusion criteria included pre-existing nephropathy, contrast-induced nephropathy, and dialysis dependence.
    • Data collected encompassed preoperative, intraoperative, and postoperative variables.

    Main Results:

    • The incidence of AKI was 16.5% (33 out of 200 patients), with 2 requiring hemodialysis.
    • Independent predictors of AKI included intraoperative blood transfusions (OR 1.41 per unit), pneumonia (OR 15.32), and vasoactive drug use (OR 4.13).
    • Mortality was significantly higher in patients with AKI (39.4%) compared to those without (4.8%).

    Conclusions:

    • AKI is a significant complication after MAS with a high mortality rate.
    • Intraoperative blood transfusions, pneumonia, and vasoactive drug use are key independent predictors of AKI.
    • Early identification of these predictors can guide preventative strategies to reduce AKI and mortality after MAS.

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