Response to Postoperative Acute Kidney Injury: Does Knowledge Equate to Action?

Acute kidney injury (AKI) is a frequent postoperative complication and is associated with substantial short- and long-term morbidity. Although the adoption of standardized diagnostic criteria has improved recognition of AKI, less is known about how surgical teams manage, document, and ensure appropriate follow-up after AKI.

We conducted a retrospective cohort study of adults who developed postoperative AKI at a tertiary medical center over a 2-y period. Primary outcomes included the frequency of AKI-related management interventions, completeness of AKI documentation, and follow-up practices. Secondary outcomes included comparisons by AKI severity, perioperative exposure quantification, and 30-d mortality.

Most patients (93.3%) developed stage 2 or 3 AKI, and kidney replacement therapy was initiated for 18.3% of cases. Following AKI, nonsteroidal anti-inflammatory drugs were avoided in 97.1% of cases, and diuretics were not administered in 81.7% of cases, whereas opioid dose reduction occurred in only 4.8% of cases. AKI was explicitly documented in 63.5% of clinical notes and in 38.5% of discharge summaries. After AKI onset, 40.4% of patients received an inpatient medicine or nephrology consultation, and 6.7% were referred to nephrology after hospital discharge. Postdischarge laboratory follow-up within 30 d occurred in 58.7% of patients, and the 30-d mortality rate was 18.3%.

Despite the high prevalence of perioperative renal insults, postoperative AKI management, documentation, and follow-up were inconsistent and frequently incomplete. These findings highlight critical gaps in perioperative renal care and underscore the need for coordinated multi-institutional efforts for standardized care practices to improve outcomes following postoperative AKI.