How Much Do We Know About Acute Kidney Injury Following Pneumonectomy? A Retrospective Study

Acute kidney injury (AKI) is a significant postoperative complication of thoracic surgery, but data on AKI after pneumonectomy remain scarce. This study aimed to determine the incidence, risk factors, and short-term outcomes of AKI, as defined by Kidney Disease Improving Global Outcomes 2012 criteria, occurring within one week after pneumonectomy.

This retrospective single-center cohort included adults who underwent elective pneumonectomy between 2008-2018. Patients with preoperative chronic kidney disease or AKI, or with missing data, were excluded. Demographic, perioperative, and postoperative data were collected from hospital records. AKI was identified based on postoperative creatinine values measured within one week. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

Of the 308 patients, 166 met the inclusion criteria. The incidence of AKI was 12% (19 stage 1, 1 stage 2); none required renal replacement therapy. In multivariate analysis, increased body mass index [odds ratio (OR): 1.10, 95% confidence interval (CI): 1.01-1.21, P = 0.038]; acetylsalicylic acid use (OR: 10.56, 95% CI: 1.58-70.60, P = 0.015); higher intraoperative fluid volume (OR: 1.00, 95% CI: 1.00-1.00, P = 0.036); and length of stay (OR: 1.07, 95% CI: 1.01-1.13, P = 0.016) were associated with increased AKI risk, while nonsteroidal anti-inflammatory drug use was independently protective (OR: 0.03, 95% CI: 0.00-0.13, P < 0.001), as was diuretic use (OR: 0.06, 95% CI: 0.01-0.50, P = 0.009). AKI was associated with longer hospitalization but not with increased mortality.

Reducing the incidence of AKI may improve patient outcomes, and AKI should be considered a key quality indicator in thoracic surgery. Identifying and understanding the risk factors for AKI may provide the foundation for predictive models and guide strategies to prevent this complication.