Acute kidney injury after major non-cardiac surgery: Incidence and risk factors
Background. Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI pos...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2023-03-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/819 |
| _version_ | 1797368007121436672 |
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| author | E Rossouw S Chetty |
| author_facet | E Rossouw S Chetty |
| author_sort | E Rossouw |
| collection | DOAJ |
| description |
Background. Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI post major surgery has been evaluated; however, there are no data available for South Africa (SA).Objectives. To ascertain the incidence of AKI after major non-cardiac surgery at a tertiary academic SA hospital. Secondary outcomes wereto identify perioperative risk factors that are associated with an elevated risk to develop AKI in the postoperative period.Methods. The study was conducted at Tygerberg Hospital, a single tertiary centre in Cape Town, SA. Perioperative records of adults whounderwent major non-cardiac surgery were retrospectively collected. Variables pertaining to potential risk factors for AKI were captured,and serum creatinine levels were recorded up to 7 days postoperatively and compared with baseline measurements to determine whetherAKI had developed. Descriptive statistics along with logistic regression analysis were used to interpret results.Results. The overall incidence of AKI was 11.2% (95% confidence interval (CI) 9.8 - 12.6). Based on surgical discipline, trauma surgery(19%), followed by abdominal (18.5%) and vascular surgery (17%) had the highest incidence. Independent AKI risk factors wereidentified after multivariate analysis. These were: chronic obstructive pulmonary disease (odds ratio (OR) 2.19; 95% CI 1.09 - 4.37;p=0.005), trauma surgery (OR 3.00; 95% CI 1.59 - 5.64; p=0.001), abdominal surgery (OR 2.14; 95% CI 1.33 - 3.45; p=0.002), vascularsurgery (OR 2.42; 95% CI 1.31 - 4.45; p=0.004), urology procedures (OR 2.45; 95% CI 1.31 - 4.45; p=0.005), red blood cell transfusion(OR 1.81; 95% CI 1.21 - 2.70; p=0.004), emergency surgery (OR 1.74; 95% CI 1.15 - 2.65; p=0.009) and inotrope use (OR 2.77; 95% CI1.80 - 4.26; p<0.001).Conclusion. The results of our study are in keeping with international literature regarding the incidence of AKI after major non-cardiacsurgery. The risk factor profile, however, is in several regards different from what has been found elsewhere
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| first_indexed | 2024-03-08T17:25:20Z |
| format | Article |
| id | doaj.art-1832cee2766f48aa844f979e63154644 |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T17:25:20Z |
| publishDate | 2023-03-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-1832cee2766f48aa844f979e631546442024-01-02T19:27:09ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-03-01113310.7196/SAMJ.2023.v113i3.16783Acute kidney injury after major non-cardiac surgery: Incidence and risk factorsE Rossouw0S Chetty1Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaDepartment of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Background. Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI post major surgery has been evaluated; however, there are no data available for South Africa (SA).Objectives. To ascertain the incidence of AKI after major non-cardiac surgery at a tertiary academic SA hospital. Secondary outcomes wereto identify perioperative risk factors that are associated with an elevated risk to develop AKI in the postoperative period.Methods. The study was conducted at Tygerberg Hospital, a single tertiary centre in Cape Town, SA. Perioperative records of adults whounderwent major non-cardiac surgery were retrospectively collected. Variables pertaining to potential risk factors for AKI were captured,and serum creatinine levels were recorded up to 7 days postoperatively and compared with baseline measurements to determine whetherAKI had developed. Descriptive statistics along with logistic regression analysis were used to interpret results.Results. The overall incidence of AKI was 11.2% (95% confidence interval (CI) 9.8 - 12.6). Based on surgical discipline, trauma surgery(19%), followed by abdominal (18.5%) and vascular surgery (17%) had the highest incidence. Independent AKI risk factors wereidentified after multivariate analysis. These were: chronic obstructive pulmonary disease (odds ratio (OR) 2.19; 95% CI 1.09 - 4.37;p=0.005), trauma surgery (OR 3.00; 95% CI 1.59 - 5.64; p=0.001), abdominal surgery (OR 2.14; 95% CI 1.33 - 3.45; p=0.002), vascularsurgery (OR 2.42; 95% CI 1.31 - 4.45; p=0.004), urology procedures (OR 2.45; 95% CI 1.31 - 4.45; p=0.005), red blood cell transfusion(OR 1.81; 95% CI 1.21 - 2.70; p=0.004), emergency surgery (OR 1.74; 95% CI 1.15 - 2.65; p=0.009) and inotrope use (OR 2.77; 95% CI1.80 - 4.26; p<0.001).Conclusion. The results of our study are in keeping with international literature regarding the incidence of AKI after major non-cardiacsurgery. The risk factor profile, however, is in several regards different from what has been found elsewhere https://samajournals.co.za/index.php/samj/article/view/819Acute kidney injurysurgery |
| spellingShingle | E Rossouw S Chetty Acute kidney injury after major non-cardiac surgery: Incidence and risk factors South African Medical Journal Acute kidney injury surgery |
| title | Acute kidney injury after major non-cardiac surgery: Incidence and risk factors |
| title_full | Acute kidney injury after major non-cardiac surgery: Incidence and risk factors |
| title_fullStr | Acute kidney injury after major non-cardiac surgery: Incidence and risk factors |
| title_full_unstemmed | Acute kidney injury after major non-cardiac surgery: Incidence and risk factors |
| title_short | Acute kidney injury after major non-cardiac surgery: Incidence and risk factors |
| title_sort | acute kidney injury after major non cardiac surgery incidence and risk factors |
| topic | Acute kidney injury surgery |
| url | https://samajournals.co.za/index.php/samj/article/view/819 |
| work_keys_str_mv | AT erossouw acutekidneyinjuryaftermajornoncardiacsurgeryincidenceandriskfactors AT schetty acutekidneyinjuryaftermajornoncardiacsurgeryincidenceandriskfactors |