Abstract
BackgroundPostoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes.MethodsWe conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline.ResultsOf the 4718 patients, 679 (14.4%) developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2%) were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl); use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments.ConclusionsAKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.
Highlights
The incidence of gastric cancer has been declining in most advanced nations over the past 2 decades, it remains a major cause of morbidity and mortality worldwide as well as one of the most common malignancies in many east Asian countries [1,2]
acute kidney injury (AKI) is a serious morbidity occurring during hospitalizations, and it is associated with prolonged hospital stay, high risk of inhospital mortality and increased hospital costs [8]
We excluded patients who died within 24 hours of gastric surgery because their mortality was not associated with renal dysfunction and the data were inappropriate for the evaluation of postoperative renal dysfunction
Summary
The incidence of gastric cancer has been declining in most advanced nations over the past 2 decades, it remains a major cause of morbidity and mortality worldwide as well as one of the most common malignancies in many east Asian countries [1,2]. The risk factors for postoperative acute kidney injury (AKI) and its effects on the clinical outcomes are not well understood in patients with gastric cancer. AKI is a serious morbidity occurring during hospitalizations, and it is associated with prolonged hospital stay, high risk of inhospital mortality and increased hospital costs [8]. AKI increases the risk of incident and progressive chronic kidney disease and is associated with reduced long-term survival [9]. Postoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes
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