Evaluation of the Frequency of Kidney Injury in the Postoperative Critical Care Unit (PACU): A Prospective Observational Study

Öz

Background: In the study, the frequency of postoperative acute kidney injury (AKI), factors associated with AKI, and the effect of AKI on outcomes in surgical cases treated in the Postoperative intensive care unit (PACU) in the postoperative period were investigated. Materials and Method: The study is a prospective and observational study. Surgical cases treated in the PACU in the postoperative period were included in our study. Demographic characteristics of the patients, characteristics of the operation and anesthesia, Charlson Comorbidity Index (CCI) values, American Society of Anesthesiologist (ASA) risk classes, preoperative biochemistry results and preoperative hemogram results were recorded. Patients' AKI was assessed using the Risk, Injury, Failure, Loss of Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network criteria(AKIN). Results: 583 postoperative cases were examined. The frequency of AKI in PACU was 17,7%. Age, preoperative CCI, BUN, GFR values, preoperative peptic ulcer history, preoperative calcium, total bilirubin levels and the urgency of operation were the preoperative reasons for AKI. Intraoperative use of blood and colloid also affected postoperative AKI. There was a relationship between AKI and the amount of crystalloid and FFP used in PACU. In patients with AKI, the frequency of inotropic use in PACU, the frequency of the use of IMV and the duration, cardiac complication, arrhythmia, respiratory system complications, sepsis and mortality rate were higher compared to patients without AKI (p <0.05). Conclusion: In the postoperative period, the frequency of AKI was found to be 17.7% in patients treated in PACU. It was determined that there was a relationship between age, CCI, BUN, GFR, calcium, bilirubin values and the urgency of the operation and postoperative AKI. The development of AKI in the postoperative period is associated with increased morbidity and mortality.

Anahtar Kelimeler

• Acute Kidney Injury
• Postoperative
• PACU
• Critical Care

Ameliyat Sonrası Yoğun Bakım Ünitesinde (PACU) Böbrek Hasarı Sıklığının Değerlendirilmesi: Prospektif Gözlemsel Bir Çalışma

Öz

Giriş: Bu çalışmada postoperatif yoğun bakım ünitesinde tedavi edilen cerrahi olgularda postoperatif dönemde, postoperatif akut böbrek hasarı (ABH) sıklığı, ABH ile ilişkili faktörler ve ABH'nin sonuçlar üzerine etkisi araştırılmıştır. Gereç ve Yöntem: Bu çalışma prospektif ve gözlemsel bir çalışmadır. Çalışmamıza postoperatif dönemde PACU'da tedavi edilen cerrahi vakalar dahil edilmiştir. Hastaların demografik özellikleri, ameliyat ve anestezi özellikleri, Charlson Komorbidite İndeksi (CCI) değerleri, Amerikan Anesteziyoloji Derneği (ASA) risk sınıfları, ameliyat öncesi biyokimya sonuçları ve ameliyat öncesi hemogram sonuçları kaydedildi. Hastaların AKI'si Risk, Yaralanma, Başarısızlık, Fonksiyon Kaybı ve Son Dönem Böbrek Hastalığı (RIFLE) ve Akut Böbrek Hasarı Ağı (AKIN) kriterleri kullanılarak değerlendirildi. Bulgular: Çalışmamızda postoperatif erken dönemde böbrek hasarlanması sıklığı %17,7 olarak belirlendi. Yaş, preoperatif CCI, BUN, GFR, kalsiyum, total bilüribün değerleri, preoperatif peptik ulkus öyküsü, operasyonun aciliyeti, intraoperatif kan ve kolloid kullanım sıklığı, PACU'da kristaloid ve TDP miktarı, PACU'da kolloid kullanımı sıklığı ile postoperatif akut böbrek hasarı arasında ilişki bulunduğu belirlenmiştir (p<0.05). Postoperatif böbrek hasarı gelişen olgularda PACU'da inotrop kullanım sıklığı, invaziv mekanik ventilatör kullanım sıklığı ve süresi, PACU yatış süresinin arttığı, kardiyak komplikasyon, aritmi, atrial fibrilasyon, solunum sistemi komplikasyonları, sepsis, nörolojik komplikasyonlar, postoperatif deliryum ve mortalite sıklığının yükseldiği belirlenmiştir (p<0.05). Sonuç: Postoperatif yoğun bakım ünitesinde takip edilen olgularda erken dönemde böbrek hasarlanması sıklığı %17,7 olarak belirlenmiştir. Yaş, CCI, BUN, GFR, kalsiyum, bilirubin değerleri ve ameliyatın aciliyeti ile postoperatif AKI arasında ilişki olduğu tespit edilmiştir. Postoperatif dönemde AKI gelişimi artmış morbidite ve mortalite ile ilişkilidir.

Anahtar Kelimeler

• Akut böbrek yetersizliği
• Postoperatif
• PACU
• Yoğun Bakım

Kaynakça

1. 1. Chu CK, Mazo AE, Sarmiento JM, Staley CA, Adsay NV, Umpierrez GE, et al. Impact of Diabetes Mellitus on Perioperative Outcomes after Resection for Pancreatic Adenocarcinoma. J Am Coll Surg. 2010 Apr 1;210(4):463–73.
2. 2. Squires M, Mehta V, Fisher S, … NL-J of the A, 2014 U. Effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection: a single institution experience of 1,061 consecutive patients. Elsevier [Internet]. 2014 [cited 2022 Aug 2];218(1):92–101. Available from: https://www.sciencedirect.com/science/article/pii/S1072751513010892
3. 3. Iwasaki Y, Sawada T, Kijima H, Kosuge T, Katoh M, Rokkaku K, et al. Estimated glomerular filtration rate is superior to measured creatinine clearance for predicting postoperative renal dysfunction in patients undergoing pancreatoduodenectomy. Pancreas [Internet]. 2010 Jan [cited 2022 Aug 2];39(1):20–5. Available from: https://journals.lww.com/pancreasjournal/Fulltext/2010/01000/Estimated_Glomerular_Filtration_Rate_Is_Superior.5.aspx
4. 4. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care [Internet]. 2004 May 24 [cited 2022 Aug 2];8(4):1–9. Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc2872
5. 5. Stevens PE, Tamimi NA, Al-Hasani MK, Mikhail AI, Kearney E, Lapworth R, et al. Non‐specialist management of acute renal failure. QJM An Int J Med [Internet]. 2001 Oct 1 [cited 2022 Aug 2];94(10):533–40. Available from: https://academic.oup.com/qjmed/article/94/10/533/1558984
6. 6. Abosaif NY, Tolba YA, Heap M, Russell J, Nahas AM El. The Outcome of Acute Renal Failure in the Intensive Care Unit According to RIFLE: Model Application, Sensitivity, and Predictability. Am J Kidney Dis. 2005 Dec 1;46(6):1038–48.
7. 7. Ozbilgin Ş, Hanci V, Ömür D, Özbilgin M, Tosun M, Yurtlu S, et al. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine (Baltimore) [Internet]. 2016 [cited 2022 Aug 2];95(40). Available from: /pmc/articles/PMC5059069/
8. 8. Romagnoli S, Zagli G, Tuccinardi G, Tofani L, Chelazzi C, Villa G, et al. Postoperative acute kidney injury in high-risk patients undergoing major abdominal surgery. J Crit Care. 2016 Oct 1;35:120–5.

9. 9. Mikkelsen TB, Schack A, Oreskov JO, Gögenur I, Burcharth J, Ekeloef S. Acute kidney injury following major emergency abdominal surgery – a retrospective cohort study based on medical records data. BMC Nephrol [Internet]. 2022 Dec 1 [cited 2022 Aug 2];23(1):1–11. Available from: https://link.springer.com/articles/10.1186/s12882-022-02708-8
10. 10. Sin EIL, Chia CS, Tan GHC, Soo KC, Teo MCC. Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Int J Hyperth [Internet]. 2017 Aug 18 [cited 2022 Aug 2];33(6):690–5. Available from: https://www.tandfonline.com/doi/abs/10.1080/02656736.2017.1293304
11. 11. Dewi F, Egan RJ, Abdelrahman T, Morris C, Stechman MJ, Lewis WG. Prognostic Significance of Acute Kidney Injury Following Emergency Laparotomy: A Prospective Observational Cohort Study. World J Surg [Internet]. 2018 Nov 1 [cited 2022 Aug 2];42(11):3575–80. Available from: https://link.springer.com/article/10.1007/s00268-018-4744-1
12. 12. Zhang P, Guan C, Li C, Zhu Z, Zhang W, Luan H, et al. A visual risk assessment tool for acute kidney injury after intracranial aneurysm clipping surgery. Ren Fail [Internet]. 2020 Jan 1 [cited 2022 Aug 2];42(1):1093–9. Available from: https://www.tandfonline.com/doi/abs/10.1080/0886022X.2020.1838299
13. 13. Kim M, Kiran RP, Li G. Acute kidney injury after hepatectomy can be reasonably predicted after surgery. J Hepatobiliary Pancreat Sci [Internet]. 2019 Apr 1 [cited 2022 Aug 2];26(4):144–53. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jhbp.615
14. 14. Lim C, Audureau E, Salloum C, Levesque E, Lahat E, Merle JC, et al. Acute kidney injury following hepatectomy for hepatocellular carcinoma: incidence, risk factors and prognostic value. HPB. 2016 Jun 1;18(6):540–8.
15. 15. Bredt LC, Peres LAB. Risk factors for acute kidney injury after partial hepatectomy. World J Hepatol [Internet]. 2017 Jun 6 [cited 2022 Aug 2];9(18):815. Available from: /pmc/articles/PMC5491404/
16. 16. Cho E, Kim SC, Kim MG, Jo SK, Cho WY, Kim HK. The incidence and risk factors of acute kidney injury after hepatobiliary surgery: A prospective observational study. BMC Nephrol [Internet]. 2014 Oct 23 [cited 2022 Aug 2];15(1):1–8. Available from: https://link.springer.com/articles/10.1186/1471-2369-15-169
17. 17. Reese T, Kröger F, Makridis G, Drexler R, Jusufi M, Schneider M, et al. Impact of acute kidney injury after extended liver resections. HPB. 2021 Jul 1;23(7):1000–7.
18. 18. Kim BR, Yoon S, Song GY, Lee S, Bahk JH, Nam K. The impact of total intravenous anesthesia versus inhalation anesthesia on acute kidney injury after major abdominal surgery: a propensity score analysis. J Anesth [Internet]. 2021 Feb 1 [cited 2022 Aug 2];35(1):112–21. Available from: https://link.springer.com/article/10.1007/s00540-020-02882-9
19. 19. Hanipah ZN, Punchai S, Augustin T, Brethauer S, Schauer P, Aminian A. Impact of early post-bariatric surgery acute kidney injury on long-term renal function. Surg Obes Relat Dis [Internet]. 2017 Oct 1 [cited 2022 Aug 2];13(10):3580–5. Available from: http://www.soard.org/article/S1550728917307931/fulltext
20. 20. Zhang J, Feng G, Yang Y, Zhang P, Pu C, Zhao G. Acute kidney injury after radical gastrectomy: A single center study. Int Urol Nephrol [Internet]. 2014 May 1 [cited 2022 Aug 2];46(5):973–7. Available from: https://link.springer.com/article/10.1007/s11255-013-0618-5
21. 21. Kim CS, Oak CY, Kim HY, Kang YU, Choi JS, Bae EH, et al. Incidence, Predictive Factors, and Clinical Outcomes of Acute Kidney Injury after Gastric Surgery for Gastric Cancer. PLoS One [Internet]. 2013 Dec 9 [cited 2022 Aug 2];8(12):e82289. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082289
22. 22. Lee EH, Ryul Kim H, Baek SH, Kim KM, Chin JH, Choi DK, et al. Risk Factors of Postoperative Acute Kidney Injury in Patients Undergoing Esophageal Cancer Surgery. J Cardiothorac Vasc Anesth. 2014 Aug 1;28(4):936–42.
23. 23. Konda P, Ai D, Guerra CE, Rodriguez-Restrepo A, Mehran RJ, Rice D, et al. Identification of Risk Factors Associated With Postoperative Acute Kidney Injury After Esophagectomy for Esophageal Cancer. J Cardiothorac Vasc Anesth. 2017 Apr 1;31(2):474–81.
24. 24. Joo EY, Kim YJ, Go Y, Song JG. Relationship between perioperative thyroid function and acute kidney injury after thyroidectomy. Sci Rep [Internet]. 2018 Sep 10 [cited 2022 Aug 2];8(1):1–7. Available from: https://www.nature.com/articles/s41598-018-31946-w
25. 25. Hong SE, Kim TY, Yoo JH, Kim JK, Kim SG, Kim HJ, et al. Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery. PLoS One [Internet]. 2017 Apr 1 [cited 2022 Aug 2];12(4):e0176259. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176259
26. 26. Braüner Christensen J, Aasbrenn M, Sandoval Castillo L, Ekmann A, Giver Jensen T, Pressel E, et al. Predictors of Acute Kidney Injury After Hip Fracture in Older Adults. Geriatr Orthop Surg Rehabil [Internet]. 2020 Apr 14 [cited 2022 Aug 2];11:2151459320920088. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32313715
27. 27. McKeag P, Spence A, Hanratty B. Acute kidney injury following surgery for hip fracture. Acta Ortopédica Bras [Internet]. 2020 May 22 [cited 2022 Aug 2];28(3):128–30. Available from: http://www.scielo.br/j/aob/a/9Dhx55fhPFHTt65dfm39TyD/abstract/?lang=en
28. 28. Ulucay C, Eren Z, Kaspar EC, Ozler T, Yuksel K, Kantarci G, et al. Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals. Geriatr Orthop Surg Rehabil [Internet]. 2012 Feb 28 [cited 2022 Aug 2];3(4):150–6. Available from: https://journals.sagepub.com/doi/full/10.1177/2151458512473827
29. 29. Pedersen AB, Gammelager H, Kahlert J, Sørensen HT, Christiansen CF. Impact of body mass index on risk of acute kidney injury and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int [Internet]. 2017 Mar 1 [cited 2022 Aug 2];28(3):1087–97. Available from: https://link.springer.com/article/10.1007/s00198-016-3836-8
30. 30. Agar A, Gulabi D, Sahin A, Gunes O, Hancerli CO, Kılıc B, et al. Acute kidney injury after hip fracture surgery in patients over 80 years of age. Arch Orthop Trauma Surg [Internet]. 2021 May 31 [cited 2022 Aug 2];1:1–8. Available from: https://link.springer.com/article/10.1007/s00402-021-03969-y
31. 31. Kang JS, Moon KH, Youn YH, Park JS, Ko SH, Jeon YS. Factors associated with postoperative acute kidney injury after hip fractures in elderly patients. J Orthop Surg [Internet]. 2020 Jan 1 [cited 2022 Aug 2];28(1). Available from: https://journals.sagepub.com/doi/full/10.1177/2309499019896237
32. 32. Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Bathini T, Vallabhajosyula S, et al. Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients. Sci Reports 2020 101 [Internet]. 2020 Jul 23 [cited 2022 Aug 2];10(1):1–6. Available from: https://www.nature.com/articles/s41598-020-69405-0
33. 33. Wu YH, Wu CY, Cheng CY, Tsai SF. Severe hyperbilirubinemia is associated with higher risk of contrast-related acute kidney injury following contrast-enhanced computed tomography. PLoS One [Internet]. 2020 Apr 1 [cited 2022 Aug 2];15(4):e0231264. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231264
34. 34. Blackburn A, Gunda S, Lopez B, Edwards J, Spittle N, Preston R, et al. Risk prediction for acute kidney injury in acute medical admissions in the UK. QJM. 2019 Mar 1;112(3):197–205.
35. 35. Myers RP, McLaughlin K, Hollomby DJ. Acute interstitial nephritis due to omeprazole. Am J Gastroenterol. 2001 Dec 1;96(12):3428–31.
36. 36. Hatakeyama Y, Horino T, Matsumoto T, Terada Y, Okuhara Y. Long-term continuous use of proton-pump inhibitors is associated with renal function decline in patients without acute kidney injury. Clin Exp Nephrol [Internet]. 2021 Oct 1 [cited 2022 Aug 2];25(10):1087–92. Available from: https://link.springer.com/article/10.1007/s10157-021-02066-zsurgeons. Foot Ankle Int.6:507-12 https://doi.org/10.3113/fai.2012.0507.