Key result
AKI complicates ~11% of major non-cardiac surgeries, linked to COPD, trauma, transfusions, and inotrope use.
Why the study?
Less is known regarding the incidence and risk factors of acute kidney injury after major non-cardiac surgery, and no data were available for South Africa.
Cohort (n=2,015)
No
Answers are grounded in this paper and cite their sources.
The incidence of AKI after major non-cardiac surgery in a South African tertiary center is 11.2%, with specific risk factors including COPD, emergency surgery, and inotrope use.
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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Rossouw et al. (2023) conducted a cohort in Major non-cardiac surgery (n=2,015). Major non-cardiac surgery was evaluated on Incidence of acute kidney injury (AKI) up to 7 days postoperatively (95% CI 9.8 - 12.6). The overall incidence of acute kidney injury after major non-cardiac surgery was 11.2%, with independent risk factors including COPD, trauma, abdominal and vascular surgery, emergency surgery, red blood cell transfusion, and inotrope use.
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