The Risk Factors Of Acute Kidney Injury After Surgery For Digestive Tract Malignancy:A Retrospective Cohort Analysis

Objective: To assess the incidence and risk factors of acute kidney injury(AKI)after surgery for digestive tract malignancy and provide available anesthesia management.Methods: All patients who underwent digestive tract malignancy surgery between June 1,2017,and October 31,2019,at the Union Hospital Affiliated to Fujian Medical University were included and their perioperative serum creatinine(Scr)measurements used to identify AKI after surgery employing the Kidney Disease: Improving Global Outcome(KDIGO)criteria.In this study,univariate analysis and binary Logistic multivariate regression analysis were used to determine the perioperative factors related to the occurrence of postoperative AKI.Result: A total of 1623 patients were enrolled in this study,of which 622 cases underwent laparoscopic gastric malignancy surgery,455 cases underwent laparoscopic colorectal malignancy surgery,and 546 cases underwent radical esophagectomy surgery.According to KDIGO criteria,the total incidence of AKI was 3.5%(56/1623).Among them,the incidence of AKI in patients underwent laparoscopic gastric malignancy surgery was 2.1%(13/622),the incidence of postoperative AKI in patients underwent laparoscopic colorectal malignancy surgery was 2.4%(11/455),and the incidence of AKI in patients underwent radical esophagectomy surgery was 5.9%(32/546).According to statistical methods,intraoperative infusion volume was divided into two groups:(1)The incidence of AKI in the first group [the intraoperative volume≥ 12ml/(kg·h)] was 6.81%(9/123).(2)The incidence of AKI in the second group[the intraoperative volume< 12ml/(kg·h)] was 3.15%(47/1444).After univariate analysis,it’s found that there were statistically significant differences between the postoperative AKI group and the non-AKI group in gender,age,ASA classification,smoking history,drinking history,hypertension,operation duration,intraoperative infusion volume,intraoperative hypotension,postoperative ICU admission and postoperative hospital stay.In logistic regression analysis,the independent risk factors of AKI were male(OR= 2.188,95%CI 1.038-4.612,P= 0.04),hypertension(OR= 2.302,95% CI 1.277-4.150,P= 0.006),operation duration(OR= 1.716,95%CI 1.408-2.090,P< 0.01),intraoperative infusion volume≥12ml/(kg·h)(OR= 5.240,95%CI 2.239-12.264,P< 0.01),intraoperative hypotension(OR= 2.072,95%CI 1.163-3.690,P= 0.013),postoperative ICU admission(OR= 3.914,95%CI 1.929-7.942,P< 0.01).In order to eliminate the influence of the surgical site on the intraoperative infusion volume,it’s divided into two groups by different surgical sites:(1)The volume during laparoscopic gastrointestinal malignancy surgery was divided into three groups: the incidence of AKI in the first group [intraoperative infusion volume> 9.0ml/(kg·h)] was 2.3%(8/355),the incidence of AKI in the second group [intraoperative infusion volume≤6.0ml/(kg·h)] was 4.8%(11/229),the incidence of AKI in the last group [≤9.0ml/(kg·h)the intraoperative infusion volume> 6.0ml/(kg· h)] was 1.1%(5/469).After univariate analysis,the difference between the three groups was found to be statistically significant.In logistic regression analysis,the independent risk factors of AKI were hypertension,operation duration,intraoperative hypotension and postoperative ICU admission.(2)The volume during radical esophagectomy surgery was divided into three groups: the incidence of AKI in the first group [the intraoperative infusion volume> 6.8ml/(kg·h)] was 7.0%(16/239),the incidence of AKI in the second group [the intraoperative infusion volume ≤ 5.5ml/(kg·h)] was 8.8%(14/159),the incidence of AKI in last group [6.8ml/(kg·h)≥the intraoperative infusion volume> 5.5ml/(kg·h)] was 1.4%(2/148).After univariate analysis,the difference between the three groups was found to be statistically significant.In logistic regression analysis,the independent risk factors of AKI was postoperative ICU admission.Conclusion: Our study found that,(1)the independent risk factors of AKI after surgery for digestive tract malignancy were male,hypertension,operation duration,intraoperative infusion volume,intraoperative hypotension,postoperative ICU admission.(2)The independent risk factors of AKI after laparoscopic gastrointestinal malignancy surgery were hypertension,operation duration,intraoperative hypotension and postoperative ICU admission;the independent risk factors of AKI after radical esophagectomy surgery were hypertension,operation duration and postoperative ICU admission.