Incidence and Clinical Outcomes of Postoperative Acute Kidney Injury in Relation to Etiological Factors and Surgical Procedures

Postoperative acute kidney injury (AKI) is a frequent yet preventable complication linked with increased morbidity, mortality, and healthcare burden. Multiple perioperative risk factors contribute to its development. This study aimed to determine the incidence, clinical outcomes, and independent predictors of postoperative AKI across various surgical procedures. This cross-sectional observational study was conducted at the Department of Surgery at a tertiary care hospital between November 2023 and July 2024. A total of 175 adult patients undergoing general surgical procedures under regional or general anesthesia were enrolled using non-probability consecutive sampling. Patients with chronic kidney disease, end-stage renal disease, or pre-existing AKI were excluded. Clinical, laboratory, and intraoperative variables were recorded using a standardized proforma. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States), with multivariable logistic regression applied to identify independent predictors of postoperative AKI. Out of 175 patients, postoperative AKI occurred in 33 individuals (18.9%), predominantly Stage 1 (63.64%). Patients with AKI were older (61.85 ± 8.51 vs. 56.23 ± 11.33 years, p = 0.008) and had higher baseline serum creatinine (1.12 ± 0.25 vs. 0.99 ± 0.15 mg/dL, p < 0.001). Significant associations with AKI included a medical history of hypertension (75.8%, OR: 6.52, p < 0.001), diabetes (45.5%, OR: 3.11, p = 0.004), ischemic heart disease (24.2%, OR: 3.47, p = 0.010), contrast exposure (24.2%, OR: 5.36, p = 0.001), and nephrotoxic drugs (48.5%, OR: 5.74, p < 0.001). ICU admission (45.5%), dialysis (18.2%), and in-hospital mortality (18.2%) were significantly higher in AKI cases (all p < 0.05). Postoperative AKI was significantly linked with adverse outcomes and identifiable clinical and operative risk factors. Focused preventive strategies and early intraoperative risk mitigation may reduce its incidence and improve surgical safety in high-risk patients.