Risk factors of acute kidney injury after major elective abdominal surgery: A prospective observational study

In this prospective observational study, we aimed to determine the perioperative incidence and the risk factors of acute kidney injury after elective major abdominal surgery.

Adult patients who had undergone major elective abdominal surgery were included in the study. The patients were divided into Group AKI + and Group AKI, according to KDIGO criteria at 48 hours. Patients' demographic data, preoperative status, and laboratory data, operation-related data, and postoperative laboratory and follow-up data were noted. The patients were followed up for complications and mortality within three months after the operation date.

In 425 patients included in the statistical analysis, the incidence of acute kidney injury after elective major abdominal surgery in our hospital was found to be 11.52% (49/425). In the multivariate analysis, postoperative continuation of vasopressor, mean arterial pressure <50 mmHg for at least 5 minutes, intraoperative 6% hydroxy-ethyl starch use, and high body mass index were found to be independent risk factors, in order of importance in increasing risk (OR 5.1, CI [1.4-18.9], P = 0,016; OR 3.9, CI [1.3-11.6], P = 0,014; OR 2.7, CI [1.1-6.8], P = 0,029; OR 1.2, CI [1.1-1.2], P < 0,001, respectively). 30- and 90-day mortality was found more frequently in patients who developed acute kidney injury.

In this study, we recommend modifying risk factors if possible, including avoiding 6% HES use and close blood pressure monitoring to reduce the incidence of postoperative acute kidney injury.