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Incidence and associations of acute kidney injury after major abdominal surgery

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Abstract

Purpose

Acute kidney injury (AKI) is a recognised risk factor for adverse outcomes in critical illness and hospitalised patients in general. To understand the incidence and associations of AKI as a peri-operative complication of major abdominal surgery, we conducted a systematic literature review and meta-analysis.

Methods

Using a systematic strategy, we searched the electronic reference databases for articles describing post-operative renal outcomes using consensus criteria for AKI diagnosis (RIFLE, AKIN or KDIGO) in the setting of major abdominal surgery. Pooled incidence of AKI and, where reported, pooled relative risk of death after post-operative AKI were estimated using random effects models.

Results

From 4287 screened titles, 19 articles met our inclusion criteria describing AKI outcomes in 82,514 patients undergoing abdominal surgery. Pooled incidence of AKI was 13.4 % (95 % CI 10.9–16.4 %). In eight studies that reported the short-term mortality, relative risk of death in the presence of post-operative AKI was 12.6 fold (95 % CI, 6.8–23.4). Where reported, length of stay was greater and non-renal post-operative complications were also more frequent in patients experiencing AKI.

Conclusions

Using modern consensus definitions, AKI is a common complication of major abdominal surgery that is associated with adverse patient outcomes including death. While a causative role for AKI cannot be concluded from this analysis, as an important signal of peri-operative harm, AKI should be regarded as an important surgical outcome measure and potential target for clinical interventions.

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Acknowledgments

MO’C is a National Institute for Health Research (NIHR) Academic Clinical Fellow in Intensive Care Medicine. RMP is the recipient of an NIHR Research Professorship.

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Authors and Affiliations

  1. Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK

    M. E. O’Connor, C. J. Kirwan, R. M. Pearse & J. R. Prowle

  2. William Harvey Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    M. E. O’Connor, C. J. Kirwan, R. M. Pearse & J. R. Prowle

  3. Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK

    C. J. Kirwan & J. R. Prowle

Authors
  1. M. E. O’Connor
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  2. C. J. Kirwan
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Correspondence to J. R. Prowle.

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Additional information

Take-home message:

Acute kidney injury (AKI) affects around 13 % of patients undergoing major abdominal surgery and on average its occurrence is associated with a 12-fold (95 % CI 6.8–23.4) crude risk of dying in the post-operative period. AKI is a common and important clinical signal of peri-operative harm and a potential target for measures to improve post-operative outcomes.

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O’Connor, M.E., Kirwan, C.J., Pearse, R.M. et al. Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med 42, 521–530 (2016). https://doi.org/10.1007/s00134-015-4157-7

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  • DOI: https://doi.org/10.1007/s00134-015-4157-7

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