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Acute kidney injury in major gynaecological surgery: an observational study
Author(s) -
Vaught AJ,
OzrazgatBaslanti T,
Javed A,
Morgan L,
Hobson CE,
Bihorac A
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13026
Subject(s) - medicine , rifle , acute kidney injury , odds ratio , perioperative , retrospective cohort study , creatinine , cohort , confidence interval , cohort study , logistic regression , surgery , emergency medicine , archaeology , history
Objective To assess the prevalence, outcomes and cost associated with acute kidney injury ( AKI ) defined by consensus risk, injury, failure, loss, and end‐stage kidney ( RIFLE ) criteria after gynaecologic surgery. Design Retrospective single‐centre cohort study. Setting Academic medical centre. Sample Two thousand three hundred and forty‐one adult women undergoing major inpatient gynaecologic surgery between J anuary 2000 and N ovember 2010. Methods AKI was defined by RIFLE criteria as an increase in serum creatinine greater than or equal to 50% from the reference creatinine. We used multivariable regression analyses to determine the association between perioperative factors, AKI , mortality and cost. Main outcome measures AKI , combined major adverse events (hospital mortality, sepsis or mechanical ventilation), 90‐day mortality and hospital cost. Results Overall prevalence of AKI was 13%. The prevalence of AKI was associated with the primary diagnosis. Of women with benign tumour surgeries, 5% (43/801) experienced AKI compared with 18% (211/1159) of women with malignant disease ( P < 0.001). Only 1.3% of the whole cohort had evidence of urologic mechanical injury. In a multivariable logistic regression analysis, AKI patients had nine times the odds of a major adverse event compared to patients without AKI (adjusted odds ratio 8.95, 95% confidence interval 5.27–15.22). We have identified several readily available perioperative factors that can be used to identify patients at high risk for AKI after in‐hospital gynaecologic surgery. Conclusions AKI is a common complication after major inpatient gynaecologic surgery associated with an increase in resource utilisation and hospital cost, morbidity and mortality.