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Failure to Rescue After Severe Acute Kidney Injury in Patients Undergoing Non-Cardiac Surgery.
Karamchandani, Kunal; McDowell, Brittany J; Raghunathan, Karthik; Krishnamoorthy, Vijay; Lehman, Erik B; Ohnuma, Tetsu; Bonavia, Anthony.
Afiliación
  • Karamchandani K; Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: kunal.karamchandani@utsouthwestern.edu.
  • McDowell BJ; Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
  • Raghunathan K; Department of Anesthesiology, Duke University, Durham, North Carolina; Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina.
  • Krishnamoorthy V; Department of Anesthesiology, Duke University, Durham, North Carolina; Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina.
  • Lehman EB; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania.
  • Ohnuma T; Department of Anesthesiology, Duke University, Durham, North Carolina; Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina.
  • Bonavia A; Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
J Surg Res ; 279: 148-163, 2022 11.
Article en En | MEDLINE | ID: mdl-35777347
INTRODUCTION: Many deaths after surgery can be attributed to "failure to rescue," which may be a better surgical quality indicator than the occurrence of a postoperative complication. Acute kidney injury (AKI) is one such postoperative complication associated with high mortality. The purpose of this study is to identify perioperative risk factors associated with failure to rescue among patients who develop postoperative AKI. METHODS: We identified adult patients who underwent non-cardiac surgery between 2012 and 2018 and experienced postoperative severe AKI (an increase in blood creatinine concentration of >2 mg/dL above baseline or requiring hemodialysis) from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue among patients who developed severe AKI. RESULTS: Among 5,765,904 patients who met inclusion criteria, 26,705 (0.46%) patients developed postoperative severe AKI, of which 6834 (25.6%) experienced failure to rescue. Risk factors with the strongest association (adjusted odds ratio >1.5) with failure to rescue in patients with AKI included advanced age, higher American Society of Anesthesiologists class, presence of preoperative ascites, disseminated cancer, septic shock, and blood transfusion within 72 h of surgery start time. CONCLUSIONS: About one-fourth of patients who develop severe AKI after non-cardiac surgery die within 30 d of surgery. Both patient- and surgery-related risk factors are associated with this failure to rescue. Further studies are needed to identify early and effective interventions in high-risk patients who develop postoperative severe AKI to prevent the antecedent mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesión Renal Aguda Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: J Surg Res Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesión Renal Aguda Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: J Surg Res Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos