Perioperative risk factors for acute kidney injury in major abdominal surgeries: a retrospective observatioal study

Year 2024, , 160 - 165, 28.06.2024

Emine Nilgün Zengin , Nevriye Salman , Zeliha Aslı Demir , Behiç Girgin , Hülya Yiğit Özay , Umut Cahit Ersoy , Ali Alagöz

https://doi.org/10.47582/jompac.1479651

Abstract

Aims: Acute kidney injury (AKI), particularly as a postoperative complication related to surgery, has been independently associated with morbidity and mortality. AKI also develops at a significant rate after major abdominal surgery. In this study, it was aimed to identify the risk factors contributing to the development of AKI following major abdominal surgery.
Methods: The study was retrospectively planned. Patients who underwent major abdominal surgery were included in the study. Patients’ demographic data, preoperative laboratory data, intraoperative data, and postoperative data were recorded from patient files. The diagnosis and severity of postoperative acute kidney injury (PO-AKI) were assessed using serum creatinine and/or urine output criteria in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The patients were divided into two groups: AKI and non-AKI.
Results: A total of 64 patients with complete data were included in the study. Among these patients, 6 developed AKI (9.3%). The mean age in the AKI group was found to be statistically significantly higher (p: 0.043). The Frailty index was significantly higher in the AKI group (p: 0.020). Additionally, it was observed that the use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) was statistically significantly higher in the AKI group (p: 0.022, p: 0.044, respectively). When patients were evaluated in terms of intraoperative parameters, the amount of colloid used, the amount of ES used, and vasopressor usage were found to be statistically significantly higher in the AKI group (p<0.001, p: 0.036, p: 0.022, respectively). Lastly, vasopressor usage and diuretic usage were found to be statistically significantly higher in the AKI group for postoperative period (p: 0.002, p: 0.044, respectively)
Conclusion: Many parameters covering the perioperative period can cause PO-AKI. Especially in elderly patients, frailty and age are significant factors that must be kept in mind.

Keywords

Abdominal surgery, acute kidney injury, perioperative, postoperative, risk factors

Ethical Statement

This study was retrospectively designed and received approval from the Ankara Bilkent City Hospital Hospital Ethics Committee(Ethics Committee No: E.Kurul-E1-21-1605, Date: 17.03.2021)

Supporting Institution

None

Thanks

None

Majör abdominal cerrahilerde akut böbrek hasarında perioperatif risk faktörleri

Abstract

Amaç: Akut böbrek hasarı (ABH), özellikle cerrahiye bağlı postoperatif bir komplikasyon olarak, bağımsız olarak morbidite ve mortalite ile ilişkilendirilmiştir. ABH ayrıca majör abdominal cerrahiden sonra da önemli oranda gelişir. Bu çalışmada, majör abdominal cerrahi sonrası ABH gelişimine sebep olan risk faktörlerinin belirlenmesi amaçlandı.
Gereç ve Yöntem: Çalışma retrospektif olarak planlandı. Çalışmaya majör abdominal cerrahi geçiren hastalar dahil edildi. Hasta dosyalarından hastaların demografik verileri, ameliyat öncesi laboratuvar verileri, ameliyat sırasındaki verileri ve ameliyat sonrası verileri kaydedildi. Postoperatif akut böbrek hasarının (PO-ABH) tanısı ve derecesi, KDIGO kılavuzlarına uygun olarak serum kreatinin ve/veya idrar çıkışı kriterleri ile değerlendirildi. Hastalar ABH olan ve ABH olmayan olmak üzere iki gruba ayrıldı.
Bulgular: Verileri tam olan toplam 64 hasta çalışmaya dahil edildi. Bu hastaların 6'sında (%9.3) ABH gelişti. ABH grubunda yaş ortalaması istatistiksel olarak anlamlı derecede yüksek bulundu (p:0.043). Kırılganlık indeksi ABH grubunda anlamlı derecede yüksekti (p:0.020). Ayrıca ABH grubunda aspirin ve anjiyotensin dönüştürücü enzim inhibitörü (ACEI)/anjiyotensin reseptör blokeri (ARB) kullanımının istatistiksel olarak anlamlı düzeyde daha yüksek olduğu görüldü (sırasıyla p:0.022, p:0.044). Hastalar intraoperatif parametreler açısından değerlendirildiğinde ABH grubunda, kullanılan kolloid miktarı, kullanılan ES miktarı ve vazopressör kullanımı istatistiksel olarak anlamlı derecede yüksek bulundu (p:<0.001, p:0.036, p:0.022), sırasıyla). Son olarak ABH grubunda postoperatif dönemde vazopressör kullanımı ve diüretik kullanımı istatistiksel olarak anlamlı düzeyde yüksek bulundu (sırasıyla p:0.002, p:0.044).
Sonuç: Perioperatif dönemi kapsayan birçok parametre PO-ABH'na neden olabilir. Özellikle yaşlı hastalarda kırılganlık ve yaş akılda tutulması gereken önemli faktörlerdir.

Keywords

Abdominal cerrahi, akut böbrek hasarı, periopertif, postoperatif, risk faktörleri

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