More than half of patients admitted to surgical intensive care units (SICUs) following major surgery develop postoperative acute kidney injury (AKI), a large multicenter study has revealed. The findings, published this week, underscore the significant burden of AKI in critically ill postoperative patients and highlight the need for improved risk stratification and early preventive strategies.
The retrospective analysis, involving adult patients aged 18 years and older who underwent major surgical procedures, aimed to determine the incidence of postoperative AKI and pinpoint key risk factors associated with its development. Researchers utilized statistical analyses performed using SPSS version 27, presenting their findings through detailed tables and figures.
High Incidence Signals Need for Proactive Monitoring
The study reported an incidence of AKI in the surgical intensive care setting of 53.4% (95% CI: 48.4%–58.4%). This substantial rate emphasizes the vulnerability of patients recovering from major surgery and the importance of vigilant monitoring for early signs of kidney dysfunction.
Several independent risk factors were significantly associated with the development of postoperative AKI. Sepsis emerged as the strongest predictor, with an adjusted odds ratio (AOR) of 8.2 (95% CI: 5.3–12.3). This indicates that patients experiencing sepsis are over eight times more likely to develop AKI following surgery. Trauma was also a significant risk factor (AOR: 4.8; 95% CI: 3.4–7.7), as were pre-existing conditions such as chronic kidney disease (AOR: 3.3; 95% CI: 2.1–4.8) and diabetes mellitus (AOR: 2.1; 95% CI: 1.1–4.2).
Beyond pre-existing conditions, the study identified several perioperative factors that contribute to AKI risk. Patients who received blood transfusions had more than double the risk (AOR: 2.5; 95% CI: 1.5–7.3), suggesting a potential link between transfusion practices and kidney injury. Similarly, those undergoing emergency surgery were at elevated risk (AOR: 2.6; 95% CI: 1.8–4.9), likely due to the increased physiological stress and potential for complications associated with emergency procedures.
A Multifactorial Condition Requiring Comprehensive Approach
The findings reinforce the understanding that postoperative AKI is a multifactorial condition, influenced by a complex interplay of pre-existing comorbidities and acute perioperative complications. This complexity necessitates a comprehensive approach to risk management, encompassing both proactive identification of high-risk individuals and meticulous attention to perioperative care.
The authors emphasize the critical importance of early identification of patients at high risk for AKI within SICUs. Proactive monitoring of kidney function, optimization of hemodynamic status – ensuring adequate blood flow and pressure – and careful management of blood transfusions are all potential strategies to mitigate risk. Aggressive and timely treatment of sepsis is also paramount, given its strong association with AKI development.
The study builds upon a growing body of evidence demonstrating that postoperative AKI remains a significant complication in surgical critical care. The high incidence observed underscores the need for continued research into preventative strategies and improved clinical protocols.
The authors note that, due to institutional and ethical constraints, the datasets generated and analyzed during this study are not publicly accessible. However, they are available from the corresponding author upon reasonable request.
Reference
Wubet HB et al. Postoperative acute kidney injury in surgical intensive care units: a multicenter study on incidence and risk profiles. Sci Rep. 2026; 10.1038/s41598-026-39368-9.
