Departments of Surgery, The University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Surg. 2013 Aug;258(2):359-63. doi: 10.1097/SLA.0b013e31829654f3.
To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidney dysfunction.
More than 30% of patients older than 60 years are obese and, therefore, at risk for kidney disease. Postoperative AKI is a significant problem.
We performed a matched case-control study of patients enrolled in the Obesity and Surgical Outcomes Study, using data of Medicare claims enriched with detailed chart review. Each AKI patient was matched with a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline estimated glomerular filtration rate, admission APACHE score, and the risk of death score with fine balance on hospitals.
We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (odds ratio = 1.65, P < 0.005) when compared with the nonobese patients. After adjustment for potential confounders, the odds of postoperative AKI remained elevated in the elderly obese (odds ratio = 1.68, P = 0.01.)
: Obesity is an independent risk factor for postoperative AKI in patients older than 65 years. Efforts to optimize kidney function preoperatively should be employed in this at-risk population along with keen monitoring and maintenance of intraoperative hemodynamics. When subtle reductions in urine output or a rising creatinine are observed postoperatively, timely clinical investigation is warranted to maximize renal recovery.
探讨肥胖与围手术期急性肾损伤（AKI）的关系，同时控制术前肾功能障碍。
超过 30%的 60 岁以上患者肥胖，因此存在肾脏疾病风险。术后 AKI 是一个严重的问题。
我们对肥胖和手术结果研究中的患者进行了匹配病例对照研究，使用了 Medicare 索赔数据，并通过详细的图表审查进行了补充。每位 AKI 患者均与在手术类型、年龄、性别、种族、紧急状态、转移状态、基线估计肾小球滤过率、入院时急性生理学和慢性健康评估评分以及死亡风险评分相似的非 AKI 对照患者相匹配，并在医院方面进行精细平衡。
我们确定了 514 例 AKI 病例和 694 例对照患者。在病例中，180 例（35%）为骨科手术，334 例（65%）为结肠或胸部手术。匹配后，与非肥胖患者相比，接受手术的肥胖患者在入院后 30 天内发生 AKI 的几率增加了 65%（优势比=1.65，P<0.005）。在调整潜在混杂因素后，老年肥胖患者术后 AKI 的几率仍升高（优势比=1.68，P=0.01）。
肥胖是 65 岁以上患者术后 AKI 的独立危险因素。应在高危人群中术前努力优化肾功能，并密切监测和维持术中血液动力学。术后观察到尿量减少或肌酐升高时，应及时进行临床检查，以最大限度地恢复肾功能。
