Acute kidney injury in major gynaecological surgery: an observational study. (19th August 2014)

• Record Type: Journal Article
• Authors: Vaught, AJ; Ozrazgat‐Baslanti, T; Javed, A; Morgan, L; Hobson, CE; Bihorac, A
• Is Part Of: BJOG. Volume 122:Number 10(2015:Oct.)
• Page Start: 1340
• Page End: 1348
• Publication Date: 2014-08-19
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13026
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13026-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13026-sec-0001" sec-type="section"> <title>Objective</title> <p>To assess the prevalence, outcomes and cost associated with acute kidney injury (AKI) defined by consensus risk, injury, failure, loss, and end‐stage kidney (RIFLE) criteria after gynaecologic surgery.</p> </sec> <sec id="bjo13026-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective single‐centre cohort study.</p> </sec> <sec id="bjo13026-sec-0003" sec-type="section"> <title>Setting</title> <p>Academic medical centre.</p> </sec> <sec id="bjo13026-sec-0004" sec-type="section"> <title>Sample</title> <p>Two thousand three hundred and forty‐one adult women undergoing major inpatient gynaecologic surgery between January 2000 and November 2010.</p> </sec> <sec id="bjo13026-sec-0005" sec-type="section"> <title>Methods</title> <p>AKI was defined by RIFLE criteria as an increase in serum creatinine greater than or equal to 50% from the reference creatinine. We used multivariable regression analyses to determine the association between perioperative factors, AKI, mortality and cost.</p> </sec> <sec id="bjo13026-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>AKI, combined major adverse events (hospital mortality, sepsis or mechanical ventilation), 90‐day mortality and hospital cost.</p> </sec> <sec id="bjo13026-sec-0007" sec-type="section"> <title>Results</title> <p>Overall prevalence of AKI was 13%. The prevalence of AKI was associated with the primary diagnosis. Of women with benign tumour surgeries, 5% (43/801) experienced AKI compared with 18% (211/1159) of women with malignant disease (<italic>P </italic>< 0.001). Only 1.3% of the whole cohort had evidence of urologic mechanical injury. In a multivariable logistic regression analysis, AKI patients had nine times the odds of a major adverse event compared to patients without AKI (adjusted odds ratio 8.95, 95% confidence interval 5.27–15.22). We have identified several readily available perioperative factors that can be used to identify patients at high risk for AKI after in‐hospital gynaecologic surgery.</p> </sec> <sec id="bjo13026-sec-0008" sec-type="section"> <title>Conclusions</title> <p>AKI is a common complication after major inpatient gynaecologic surgery associated with an increase in resource utilisation and hospital cost, morbidity and mortality.</p> </sec> </abstract>