M E O'Connor1,2, C J Kirwan1,2,3, R M Pearse1,2, J R Prowle4,5,6. 1. Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK. 2. William Harvey Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 3. Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK. 4. Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK. j.prowle@qmul.ac.uk. 5. William Harvey Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. j.prowle@qmul.ac.uk. 6. Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK. j.prowle@qmul.ac.uk.
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.
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.
Authors: Glenn M Chertow; Elisabeth Burdick; Melissa Honour; Joseph V Bonventre; David W Bates Journal: J Am Soc Nephrol Date: 2005-09-21 Impact factor: 10.121
Authors: W E Longo; K S Virgo; F E Johnson; C A Oprian; A M Vernava; T P Wade; M A Phelan; W G Henderson; J Daley; S F Khuri Journal: Dis Colon Rectum Date: 2000-01 Impact factor: 4.585
Authors: Azra Bihorac; Sinan Yavas; Sophie Subbiah; Charles E Hobson; Jesse D Schold; Andrea Gabrielli; A Joseph Layon; Mark S Segal Journal: Ann Surg Date: 2009-05 Impact factor: 12.969
Authors: E Sirvinskas; J Andrejaitiene; L Raliene; L Nasvytis; A Karbonskiene; V Pilvinis; J Sakalauskas Journal: Perfusion Date: 2008-11 Impact factor: 1.972
Authors: Sachin Kheterpal; Kevin K Tremper; Michael Heung; Andrew L Rosenberg; Michael Englesbe; Amy M Shanks; Darrell A Campbell Journal: Anesthesiology Date: 2009-03 Impact factor: 7.892
Authors: Lars Englberger; Rakesh M Suri; Zhuo Li; Edward T Casey; Richard C Daly; Joseph A Dearani; Hartzell V Schaff Journal: Crit Care Date: 2011-01-13 Impact factor: 9.097
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Stefanie M Croghan; Alexandra Zaborowski; Helen M Mohan; David Mulvin; Barry B McGuire; Michael Murphy; David J Galvin; Gerry Lennon; David Quinlan; Des C Winter Journal: Int J Colorectal Dis Date: 2019-06-07 Impact factor: 2.571
Authors: David A C Messerer; Rebecca Halbgebauer; Bo Nilsson; Hermann Pavenstädt; Peter Radermacher; Markus Huber-Lang Journal: Nat Rev Nephrol Date: 2020-09-21 Impact factor: 28.314