Abstract
IntroductionDevelopment of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function.MethodsThis retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output < 0.5 mL/kg/hr for > 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model.ResultsA total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent risk factor for hospital mortality (OR 3.12, 95% CI 1.41 to 6.93, P = 0.005).ConclusionsThis study shows that age, emergency and high risk surgery, ischemic heart disease, congestive heart disease, ASA physical status and RCRI score were considered risk factors for the development of AKI, in patients needing intensive care after surgery. AKI has serious impact on PACU length of stay and mortality. AKI was an independent risk factor for hospital mortality.
Highlights
Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality
As an initial step the Acute Kidney Injury Network (AKIN) group proposed the term acute kidney injury to reflect the entire spectrum of acute renal failure and developed interim diagnostic and staging criteria for AKI
A total of 1597 patients were admitted to the Post-Anaesthesia Care Unit (PACU) during the study period and 1166 patients met the inclusion criteria and were followed for the development of AKI after PACU admission
Summary
Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Acute kidney injury (AKI) is commonly seen in the perioperative period and in the intensive care unit (ICU). It is associated with a prolonged hospital stay and high morbidity and mortality [16]. The term acute kidney injury has been put forth as the preferred nomenclature to replace acute renal failure with the understanding that the AKI: acute kidney injury; AKIN: Acute Kidney Injury Network; APACHE II: Acute Physiology and Chronic Health Evaluation; ASA-PS: American Society of Anesthesiologists physical status; BMI: body mass index; CI: confidence interval; ICU: intensive care unit; LOS: length of stay; OR: odds ratio; PACU: post anesthesia care unit; RCRI: Revised Cardiac Risk Index; RIFLE: Risk, Injury, Failure, Loss and End-stage kidney disease; SAPS: Simplified Acute Physiology Score; Scr: serum creatinine
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