Acute Kidney Injury After Lung Resection Surgery: Incidence and Perioperative Risk Factors
Anesthesia & Analgesia, 05/24/2012
Ishikawa S et al. – Preoperative risk factors for AKI after lung resection surgery overlap with those established for other surgical procedures. Perioperative management seems to influence the risk of AKI after lung resection; in particular, the use of synthetic colloids may increase the risk, whereas thoracoscopic procedures may decrease the risk of AKI. Early postoperative AKI is associated with respiratory complications and prolonged hospitalization.Methods
- A retrospective, observational study of patients who underwent lung resection surgery between January 2006 and March 2010 in a tertiary care academic center was conducted.
- Postoperative AKI was diagnosed within 72hours after surgery based on the Acute Kidney Injury Network creatinine criteria.
- Logistic regression was used to model the association between perioperative factors and the risk of AKI within 72hours after surgery.
- The relationship between postoperative AKI and patient outcome including mortality, days in hospital, and the requirement of reintubation was investigated.
- A total of 1129 patients (pneumonectomy n=71, bilobectomy n=30, lobectomy n=580, segmentectomy n=35, wedge resection/bullectomy n=413) were included in the final analysis.
- Patients were an average of 61 years (SD 15) and 50% were female.
- AKI was diagnosed in 67 patients (5.9%) based on Acute Kidney Injury Network criteria (stage 1, n=59; stage 2, n=8; and stage 3, n=0) within 72hours after surgery, and only 1 patient required renal replacement therapy.
- Multivariate analysis demonstrated an independent association between postoperative AKI and hypertension (adjusted odds ratio [OR] 2.0, 95% confidence interval [CI]: 1.1–3.8), peripheral vascular disease (OR 4.4, 95% CI: 1.8–10), estimated glomerular filtration rate (OR 0.8, 95% CI: 0.69–0.93), preoperative use of angiotensin II receptor blockers (OR 2.2, 95% CI: 1.1–4.4), intraoperative hydroxyethyl starch administration (OR 1.5, 95% CI: 1.1–2.1), and thoracoscopic (versus open) procedures (OR 0.37, 95% CI: 0.15–0.90).
- Development of AKI was associated with increased rates of tracheal reintubation (12% vs 2%, P<0.001), postoperative mechanical ventilation (15% vs 3%, P<0.001), and prolonged hospital length of stay (10 vs 8days, P<0.001).
- There was no difference in mortality between the 2 groups (3% vs 1%, P=0.12).