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Published on: August 9, 2013

Severe Preoperative Infection and Postoperative Acute Kidney Injury in Children: A Two-Hit Risk Factor for Mortality

Ifeoluwa C Olakunle1, Sandra Tay1, Sibelle Aurelie Yemele Kitio1

  • 1From the Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.

Anesthesia and Analgesia
|May 27, 2026
PubMed

Insights

Severe preoperative infections significantly increase the risk of postoperative acute kidney injury (AKI) in children. Combining preoperative infection with postoperative AKI leads to a nine-fold higher mortality risk.

Area of Science:

  • Pediatric Surgery
  • Critical Care Medicine
  • Nephrology

Background:

  • Children undergoing surgery face increased risks from severe preoperative infections.
  • The link between preoperative sepsis/SIRS and postoperative AKI in pediatric surgical patients needs further investigation.
  • This study examines the impact of preoperative infections on postoperative AKI and 30-day mortality.

Purpose of the Study:

  • To evaluate if severe preoperative infections elevate the risk of postoperative AKI in pediatric surgical patients.
  • To assess the combined effect of preoperative infection and postoperative AKI on 30-day mortality.
  • To identify high-risk pediatric populations for targeted perioperative strategies.

Main Methods:

  • Retrospective cohort study of 144,718 pediatric surgical patients (2012-2023).
  • Severe preoperative infection defined as sepsis or SIRS within 48 hours before surgery.
  • Postoperative AKI defined as acute renal failure or progressive renal insufficiency within 30 days.
  • Propensity score matching and modified Poisson regression used for analysis.

Main Results:

  • Postoperative AKI occurred in 0.14% of patients.
  • Severe preoperative infection more than doubled the risk of postoperative AKI (aRR, 2.03).
  • Postoperative AKI increased 30-day mortality risk 4.6-fold (aRR, 4.64).
  • Preoperative infection alone increased mortality risk 1.8-fold (aRR, 1.83).
  • Combined preoperative infection and postoperative AKI resulted in a nine-fold higher mortality risk (aRR, 9.63).

Conclusions:

  • Severe preoperative infection is linked to increased postoperative AKI and 30-day mortality in pediatric surgical patients.
  • The synergistic effect of preoperative infection and postoperative AKI significantly elevates mortality risk.
  • Targeted perioperative interventions are crucial for high-risk pediatric surgical populations.
Abstract

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