Resumo

ROSSOUW, E  e  CHETTY, S. Acute kidney injury after major non-cardiac surgery: Incidence and risk factors. SAMJ, S. Afr. med. j. [online]. 2023, vol.113, n.3, pp.135-140. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.2023.v113i3.16783.

BACKGROUND: Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is well documented 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 were to 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 who underwent 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 whether AKI 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 were identified 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), vascular surgery (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% CI 1.80 - 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-cardiac surgery. The risk factor profile, however, is in several regards different from what has been found elsewhere

        · texto em Inglês     · Inglês ( pdf )