Walikar Beeraling Ningappa, Singla Deepak, Tripathi Debendra Kumar, Agrawal Sanjay, Talawar Praveen, Mangla Mishu
Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India.
Department of Trauma and Emergency, AIIMS, Raipur, Chhattisgarh, India.
Indian J Anaesth. 2024 Feb;68(2):170-176. doi: 10.4103/ija.ija_675_23. Epub 2024 Jan 29.
Acute kidney injury (AKI) can occur in post-laparotomy patients, with a variable incidence. This study aimed to determine the incidence of AKI in patients undergoing emergency laparotomy under general anaesthesia, the effect of preoperative variables on the development of AKI, and the association of post-operative AKI with patient outcomes.
This prospective exploratory study in patients undergoing emergency laparotomy was followed up for 7 days to determine the incidence of post-operative AKI. We determined the patients developing different severity of AKI based on kidney disease improving global outcome staging. Fisher's exact test or Chi-squared test was used to study the association of demographic variables, and various periopertaive variables on the development of postoperative AKI. The association of AKI with the duration of hospital stay was estimated using the Wilcoxon-Mann-Whitney U Test, and Fisher's exact test was used to study the association between AKI and mortality.
No patient had AKI in the pre-operative period. On day 3, 18 patients; on day 5, 28 patients; and on day 7, 24 patients developed AKI. Overall, a maximum of 33 patients (out of 100) developed AKI at any time. Our study found that the American Society of Anesthesiologists (ASA) IV and sepsis were independent risk factors for post-operative AKI. Our results also show a moderate-to-high independent association between AKI and duration of hospital stay and mortality (within 30 days).
Incidence of post-operative AKI following emergency laparotomy was 33%. Higher preoperative ASA physical status and sepsis were significantly associated with postoperative AKI development.
急性肾损伤（AKI）可发生于剖腹术后患者，发生率不一。本研究旨在确定全身麻醉下接受急诊剖腹手术患者中AKI的发生率、术前变量对AKI发生的影响以及术后AKI与患者预后的关联。
对接受急诊剖腹手术的患者进行这项前瞻性探索性研究，随访7天以确定术后AKI的发生率。我们根据改善全球肾脏病预后组织（KDIGO）分期确定发生不同严重程度AKI的患者。采用Fisher精确检验或卡方检验研究人口统计学变量以及各种围手术期变量与术后AKI发生的关联。使用Wilcoxon-Mann-Whitney U检验评估AKI与住院时间的关联，采用Fisher精确检验研究AKI与死亡率之间的关联。
术前无患者发生AKI。术后第3天，18例患者发生AKI；第5天，28例患者发生AKI；第7天，24例患者发生AKI。总体而言，在任何时间最多有33例患者（共100例）发生AKI。我们的研究发现，美国麻醉医师协会（ASA）分级为IV级和脓毒症是术后AKI的独立危险因素。我们的结果还显示，AKI与住院时间和死亡率（30天内）之间存在中度至高度的独立关联。
急诊剖腹手术后AKI的发生率为33%。术前较高的ASA身体状况和脓毒症与术后AKI的发生显著相关。
