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Background Postoperative Acute Kidney Injury (AKI) is associated with significant morbidity and mortality following major gastrointestinal surgery. The Outcomes After Kidney injury in Surgery (OAKS) prognostic score risk stratifies patients undergoing major gastrointestinal surgeries for 7-day postoperative acute kidney injury (AKI). This study aimed to perform external validation of an international elective colorectal cohort. Method The Ileus MAnagement INternational (IMAGINE) audit (January to April 2018) included consecutive adults undergoing elective colorectal resection or stoma reversal across Europe and Australasia. Multivariate logistic regression was performed using data on 7-day AKI and the OAKS prognostic variables (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery, and preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Discrimination and calibration (Hosmer–Lemeshow test) were assessed on prediction of patients at high-risk (&amp;gt;20%) of postoperative AKI. Result Of 4046 patients included across 338 centres, 13.4% (n=542) developed 7-day AKI. The model discrimination was 0.67 (95% CI = 0.65-0.70), identifying high-risk patients with low sensitivity (0.28, 95% CI: 0.25-0.32) but high specificity (0.90, 95% CI = 0.89-0.91). Furthermore, the model demonstrated good calibration (p=0.518). Conclusion Discrimination of the OAKS score for patients at high-risk of postoperative AKI in this cohort is good, and remains consistent with the derivation cohort. High-risk patients identified may represent a feasible target for interventions aimed at mitigating AKI. Take-home message Prognostic risk scores may be helpful in predicting risk of postoperative acute kidney injury in patients undergoing major abdominal surgery.

british journal of surgery

P4: EXTERNAL VALIDATION OF THE OUTCOMES AFTER KIDNEY INJURY IN SURGERY (OAKS) PROGNOSTIC SCORE TO PREDICT POSTOPERATIVE ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING MAJOR ELECTIVE COLORECTAL SURGERY