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. 2017 Jul;48(1):5-10.
doi: 10.1097/SHK.0000000000000825.

Acute Kidney Injury Following Exploratory Laparotomy and Temporary Abdominal Closure

Tyler J Loftus  1 , Azra Bihorac, Tezcan Ozrazgat-Baslanti, Janeen R Jordan, Chasen A Croft, Robert Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
Affiliations

Acute Kidney Injury Following Exploratory Laparotomy and Temporary Abdominal Closure

Tyler J Loftus et al. Shock. 2017 Jul.

Abstract

Background: Acute kidney injury (AKI) following exploratory laparotomy and temporary abdominal closure (TAC) is poorly understood but clinically significant. We hypothesized that the prevalence of AKI would be highest 96 h following TAC, early hypoxemia would predict AKI, and that AKI would be an independent predictor of mortality.

Methods: We performed a retrospective analysis of 251 acute care surgery patients managed with TAC by negative pressure wound therapy (NPWT). Kidney Disease: Improving Global Outcomes AKI stages were assessed on admission, initial TAC, and following TAC at 48 h, 96 h, and 7 d. Multivariate regression was performed to identify risk factors for AKI and inpatient mortality.

Results: Fifty-seven percent of all patients developed AKI within 7 days of laparotomy (stage 1: 14%, 2: 21%, 3: 22%). The prevalence of AKI peaked 48 h following TAC, and stage correlated with inpatient mortality (stage 0: 7%, 1: 13%, 2: 19%, 3: 37%, P < 0.001). Overall mortality was 14%. Factors predictive of stage 2 or 3 AKI at 48 h included age >65 years (OR 2.6 [95% CI 1.4-4.9]), NPWT output >30 mL/h from first TAC to 48 h (2.0 [1.1-3.9]), and three parameters at initial laparotomy: mean arterial pressure <60 mm Hg (2.9 [1.0-8.5]), temperature <36°C (2.1 [1.1-3.8]), and anion gap >21 mEq/L (1.9 [1.0-3.7]). AKI was an independent predictor of inpatient mortality (5.5 [2.5-11.8]).

Conclusions: AKI is common following TAC, reaches greatest prevalence 48 h after initial laparotomy, and is associated with increased mortality. NPWT fluid loss is a risk factor for AKI that is unique to TAC patients.

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Conflict of interest statement

The authors have no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria for the study population.
Figure 2
Figure 2
The prevalence of acute kidney injury (13) peaked 48 hours after exploratory laparotomy and temporary abdominal closure (TAC).
Figure 3
Figure 3
There was a direct correlation between inpatient mortality and acute kidney injury (AKI) stage (13) 48 hours after exploratory laparotomy and temporary abdominal closure.
Figure 4
Figure 4
Emergency general surgery (EGS) patients (n = 166) had significantly higher prevalence of stage 2 or 3 AKI than trauma patients (n = 85) on admission and at the time of initial laparotomy and temporary abdominal closure (TAC).
See this image and copyright information in PMC

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