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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
Summary
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.
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