Predictive Factors for Acute Kidney Injury After Primary Bariatric Surgery in Patients With or Without Preoperative Chronic Kidney Disease and Postoperative Complications: An Analysis of MBSAQIP Database.

INTRODUCTION

Patients who underwent bariatric surgery are at risk of dehydration and postoperative acute kidney injury (AKI). This study aimed to investigate the predictive factors of AKI after sleeve gastrectomy and gastric bypass, considering preoperative chronic kidney disease and postoperative complications as predisposing factors for AKI.

METHODS

The MBSAQIP database was analyzed to assess patients who had AKI after gastric bypass or sleeve gastrectomy between 2015 and 2020. Patients were categorized based on postoperative AKI. Multivariate logistic regression was used to identify independent predictive factors of AKI in all the patients who underwent laparoscopic primary bariatric surgery. The analysis was repeated in patients without postoperative major complications, with subgroups with or without preoperative chronic kidney disease.

RESULTS

Patients were divided into AKI (N = 1376) and non-AKI (N = 1,137,775) groups. The AKI group consists of a significantly older, more male, and black race, compared to the non-AKI group. The factors most predictive of AKI in all the patients consist of readmission within 30 days (OR = 10.10), ICU admission (OR = 7.90), septic shock (OR = 6.72), preoperative chronic kidney disease (OR = 5.95), myocardial infarction (OR = 3.9), cardiac arrest (OR = 3.5), using hypertension medication (OR = 3.3), previous organ transplant (OR = 3.2) and reintubation (OR = 3.08).

CONCLUSION

Various factors have been identified as independent predictors of AKI in patients who have undergone bariatric surgery. Recognizing these risk factors enables surgeons and clinicians to categorize patients more effectively and prioritize attention toward those at high risk, thus aiding in the prevention of AKI and its associated consequences.