Defining Subclinical Acute Kidney Injury Within 72 Hours After Minimally Invasive Esophagectomy in Prone Position and...

Area of Science:

• Nephrology
• Surgical Oncology
• Critical Care Medicine

Background:

• Minimally invasive esophagectomy (MIE) in the prone position can lead to postoperative changes in serum creatinine (sCr).
• The clinical significance of sCr increases not meeting acute kidney injury (AKI) diagnostic criteria remains under investigation.
• Identifying early indicators of kidney dysfunction is crucial for optimizing patient outcomes after major surgery.

Purpose of the Study:

• To investigate the impact of minor postoperative sCr elevations, not meeting AKI criteria, on patient outcomes following MIE.
• To compare outcomes between patients with AKI, subclinical AKI (defined as ΔsCr% ≥30%), and no significant sCr increase.
• To determine if subclinical AKI is associated with adverse postoperative events.

Main Methods:

• Retrospective cohort study of 933 patients undergoing MIE between January 2010 and December 2024.
• Patients classified into AKI group (KDIGO criteria), subclinical AKI group (ΔsCr% ≥30%), and reference group (ΔsCr% <30%).
• Comparison of postoperative outcomes including hospital stay duration and mechanical ventilation requirement among the three groups.

Main Results:

• The incidence of subclinical AKI was 1.3%.
• Patients in both the AKI and subclinical AKI groups experienced significantly longer postoperative hospital stays (≥25 days) and higher rates of mechanical ventilation compared to the reference group.
• No significant difference in these outcomes was observed between the AKI and subclinical AKI groups.

Conclusions:

• Subclinical AKI, defined by a 30% increase in sCr post-MIE, is associated with increased need for mechanical ventilation.
• The findings suggest that subclinical AKI shares similar adverse outcome risks with overt AKI after MIE.
• Preventive strategies should encompass both overt AKI and subclinical AKI to mitigate poor patient outcomes.