What is the clinical evidence from this study?

Study design: Cohort. Population: Adults (≥18 years) undergoing major emergency abdominal surgery for conditions including perforation, ischemia, abscess, bleeding or obstruction (n=703). Intervention: Major emergency abdominal surgery vs. No AKI (patients without acute kidney injury). Primary outcome: Occurrence of postoperative acute kidney injury (AKI) within 7 days defined by KDIGO criteria (null).

What does this research mean for the field?

Postoperative acute kidney injury and failure of early creatinine recovery after major emergency abdominal surgery are associated with a significantly increased risk of severe complications and mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to assess how early recovery of kidney function predicts outcomes after emergency bowel surgery.

February 28, 2026Acute and Critical Care0 citationsOpen Access

Failure of early creatinine recovery predicts poor survival after emergency surgery for bowel perforation or infarction

HKHyun Il KimHanyang University Guri Hospital MLMin Hong LeeHanyang University Guri Hospital BJByung Jun JeonHanyang University Guri Hospital

Key Result

Postoperative acute kidney injury occurred in 17.4% of patients after major emergency abdominal surgery and was associated with a 4.45-fold increased risk of death within 90 days (adjusted HR 4.45, 95% CI 2.69–7.39, P <0.0001).

Key Points

The study aims to assess how early recovery of kidney function predicts outcomes after emergency bowel surgery.
Analyzed 408 patients undergoing emergency surgery for bowel perforation or ischemia.
Defined early creatinine recovery (ECR) as serum creatinine <1.3 mg/dl by postoperative day 3.
Used multivariable logistic regression to assess associations with complications and mortality.
18.5% of patients had preoperative creatinine elevation (PCE).
58.0% of patients with PCE achieved ECR by postoperative day 3.
Failure of ECR was linked to severe complications (93.1%) and high mortality (72.4%).
ECR failure predicted complications and 30-day mortality with high odds ratios.

Study Design

Type

Cohort (n=703)

Multicenter

Structured PICO

Population

703 adults (≥18 years) undergoing major emergency abdominal surgery (within 72 h of admission) for conditions such as perforation, ischaemia, bleeding, or obstruction at a single center in Denmark.

Outcome

Incidence of postoperative acute kidney injury (AKI) within seven days of surgery, defined by KDIGO criteriahard clinical

Main Result

Effect estimate: null

Absolute Event Rate: 17.4% vs 82.6%

Limitations

Observational retrospective single-center design limiting causality and generalizability
Potential selection bias due to exclusion of patients missing baseline creatinine
Baseline creatinine defined at admission possibly underestimating total AKI incidence
No urine output data to confirm AKI diagnosis
Lack of standardized perioperative fluid management
No data on intraoperative hypotension
Potential undiagnosed chronic kidney disease not fully accounted for

Abstract

Background: Early postoperative recovery of kidney function is critical in emergency bowel surgery. This study evaluated the prognostic value of preoperative creatinine elevation (PCE) and early creatinine recovery (ECR).Methods: A total of 424 patients underwent emergency surgery for bowel perforation or ischemia from January 2019 to December 2024. Sixteen trauma-related cases (including procedure-related injuries) were excluded, leaving 408 patients for analysis. Of these, 35 patients with end-stage renal disease or chronic kidney disease—either pre-existing or newly diagnosed during hospitalization—were excluded. ECR was defined as a decrease in serum creatinine to 1.3 mg/dl. Associations with postoperative complications and 30-day mortality were estimated using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs.Results: PCE occurred in 18.5% (69/373) of the tested patients; among these, 58.0% (40/69) achieved ECR by POD 3. Failure of ECR was associated with severe complications (93.1% vs. 27.5%, P<0.001) and higher mortality (72.4% vs. 7.5%, P<0.001). In multivariable analysis, ECR failure independently predicted complications (aOR, 28.72; 95% CI, 5.44–151.58) and 30-day mortality (aOR, 32.38; 95% CI, 7.74–135.41; P<0.001 for both).Conclusions: Failure to achieve ECR is independently associated with poor survival after emergency laparotomy for peritonitis. This finding supports the use of a creatinine-based checkpoint to trigger intensified monitoring and targeted rescue interventions.

Ask AI

Helpful

Bookmark

View Full Paper

Ask AI

Helpful

Bookmark

View Full Paper

Cite This Study

Kim et al. (Fri,) conducted a cohort in Adults (≥18 years) undergoing major emergency abdominal surgery for conditions including perforation, ischemia, abscess, bleeding or obstruction (n=703). Major emergency abdominal surgery vs. No AKI (patients without acute kidney injury) was evaluated on Occurrence of postoperative acute kidney injury (AKI) within 7 days defined by KDIGO criteria (null). Postoperative acute kidney injury occurred in 17.4% of patients after major emergency abdominal surgery and was associated with a 4.45-fold increased risk of death within 90 days (adjusted HR 4.45, 95% CI 2.69–7.39, P <0.0001).

synapsesocial.com/papers/69a288060a974eb0d3c03fb0 https://doi.org/https://doi.org/10.4266/acc.003625

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: