Advertisement

Prognostic Significance of Acute Kidney Injury Following Emergency Laparotomy: A Prospective Observational Cohort Study

  • F. Dewi
  • R. J. Egan
  • T. Abdelrahman
  • C. Morris
  • M. J. Stechman
  • W. G. Lewis
Original Scientific Report
  • 12 Downloads

Abstract

Aims

Post-operative acute kidney injury (AKI) is a common and independent mortality risk factor carrying high clinical and economic cost. This study aimed to establish the incidence of AKI in patients undergoing emergency laparotomy (EL), to determine patients’ risk profile and consequent mortality.

Methods

Consecutive 239 patients of median age 68 (IQR 51–76) years, undergoing EL in a UK tertiary hospital, were studied. Primary outcome measure was AKI and in-hospital operative mortality.

Results

Ninety-five patients (39.7%) developed AKI, which was associated with in-hospital mortality in 32 patients (33.7%) compared with 7 patients (4.9%) without AKI. AKI occurred in 81.1% of all mortalities, but none occurred when AKI resolved within 48 h of EL. AKI was associated with chronic kidney disease, age, serum lactate, white cell count, pre-EL systolic blood pressure and tachycardia (p < 0.010). Median length of hospital stay in AKI survivors was 15 days compared with 11 days in the absence of AKI (p < 0.001). On multivariable analysis, only AKI at 48 h post-EL was significantly and independently associated with mortality [HR 10.895, 95% CI 3.152–37.659, p < 0.001].

Conclusion

Peri-operative AKI after EL was common and associated with a more than sixfold significant greater mortality. Pre-operative risk profile assessment and prompt protocol-driven intervention should minimise AKI and reduce EL mortality.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Metnitz P, Krenn C, Steltzer H, Lang T, Ploder J, Lenz K et al (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058CrossRefPubMedGoogle Scholar
  2. 2.
    Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53:961CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Chertow GM (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365CrossRefPubMedGoogle Scholar
  4. 4.
    Abelha F, Botelho M, Fernandes V, Barros H (2009) Determinants of postoperative acute kidney injury. Crit Care 13:R79CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kheterpal S, Tremper K, Heung M, Rosenberg A, Englesbe M, Shanks A et al (2009) Development and validation of an acute kidney injury risk index for patients undergoing general surgery. Anesthesiology 110:505–515CrossRefPubMedGoogle Scholar
  6. 6.
    Wu H, Wang W, Chen Y, Chen H (2015) The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study. Ren Fail 37(6):985–993CrossRefPubMedGoogle Scholar
  7. 7.
    Disease Kidney (2012) Improving global outcomes (KDIGO) acute kidney injury work group: KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2:1–138CrossRefGoogle Scholar
  8. 8.
    Bihorac A, Yavas S, Subbiah S, Hobson CE, Schhold JD, Gabrielli A, Layon J, Segal M (2009) Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg 249:851–858CrossRefPubMedGoogle Scholar
  9. 9.
    Kim M, Brady JE, Li G (2014) Variations in the risk of acute kidney injury across intraabdominal surgery procedures. Anesth Analg 119:1121CrossRefPubMedGoogle Scholar
  10. 10.
    Kheterpal S, Tremper K, Englesbe M, O’Reilly M, Shanks A, Fetterman D et al (2007) Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 107:892–902CrossRefPubMedGoogle Scholar
  11. 11.
    Teixeira C, Rosa R, Rodrigues N, Mendes I, Peixoto L, Dias S et al (2014) Acute kidney injury after major abdominal surgery: a retrospective cohort analysis. Crit Care Res Pract 2014:1CrossRefGoogle Scholar
  12. 12.
    Kim M, Brady J, Li G (2015) Interaction effects of acute kidney injury, acute respiratory failure and sepsis on 30-day postoperative mortality in patients undergoing high-risk intraabdominal general surgical procedures. Anesth Analg 121:1536–1546CrossRefPubMedGoogle Scholar
  13. 13.
    Symons NRA, Moorthy K, Almoudaris AM, Bottle A, Aylin P, Vincent CA et al (2013) Mortality in high-risk emergency general surgical admissions. Br J Surg 100:1318CrossRefPubMedGoogle Scholar
  14. 14.
    NELA Project Team (2015) First patient report of the national emergency laparotomy audit. Royal College of Anaesthetists, LondonGoogle Scholar
  15. 15.
    Findlay GP, Goodwin A, Goodwin A, Protopapa K, Smith N, Mason M (2011) NCEPOD: a review of the perioperative care of surgical patients. http://www.ncepod.org.uk/2011report2/downloads/POC_summary.pdf
  16. 16.
    Thomas M, Davies A, Dawnay A (2013) Acute kidney injury: prevention, detection and management (CG169). National Institute for Health and Care Excellence. https://www.nice.org.uk/Guidance/CG169
  17. 17.
    Egan RJ, Dewi F, Arkell R, Ansell J, Zouwail S, Scott-Coombes D et al (2016) Does elective parathyroidectomy for primary hyperparathyroidism affect renal function? a prospective cohort study. Int J Surg 27:138–141CrossRefPubMedGoogle Scholar
  18. 18.
    Howes TE, Cook TM, Corrigan LJ, Dalton SJ, Richards SK, Peden CJ (2015) Postoperative morbidity survey, mortality and length of stay following emergency laparotomy. Anaesthesia 70:1020CrossRefPubMedGoogle Scholar
  19. 19.
    Awad S, Herrod PJJ, Palmer R, Carty H, Abercrombie JF, Brooks A et al (2012) One-and two-year outcomes and predictors of mortality following emergency laparotomy: a consecutive series from a United Kingdom teaching hospital. World J Surg 36:2060.  https://doi.org/10.1007/s00268-012-1614-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Sabaté S, Gomar C, Canet J, Sierra P, Castillo J (2011) Risk factors for postoperative acute kidney injury in a cohort of 2378 patients from 59 hospitals. Revista Española de Anestesiología y Reanimación 58(9):548–555CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Wales Postgraduate Medical and Dental Education DeaneryCardiffUK
  2. 2.Department of SurgeryUniversity Hospital of WalesCardiffUK

Personalised recommendations