| Objective: To evaluate the incidence of acute kidney injury(AKI)after laparoscopic gastric and colorectal malignancies surgery and its associated risk factors during the perioperative period.Methods: A single center retrospective analysis method was used in this study.From June 2017 to May 2018,1208 adult patients who underwent laparoscopic gastric and colorectal malignancies surgery at the Union Hospital Affiliated to Fujian Medical University were included.The diagnostic criteria for AKI uses KDIGO’s criteria.The multivariable logistic regression analysis was used in this study to determine the relationship between perioperative factors and postoperative AKI.Results: The total incidence of postoperative AKI was 2.2%.Among them,the incidence of postoperative AKI in patients with laparoscopic gastric malignancy surgery was 2.0%(13/649),and the incidence of postoperative AKI in patients with laparoscopic colorectal malignancy surgery was 2.5%(14/559).A multivariable logistic regression analysis showed that aging was an independent risk factor for AKI after laparoscopic gastric and colorectal malignancies surgery.For each age increase of 1 year,the risk of postoperative AKI increased by 9%(adjusted odds ratio 1.090,95% confidence interval 1.045-1.137).The Intraoperative infusion volume showed a u-shaped relationship with the incidence of postoperative AKI,that is,the Intraoperative infusion volume was <5 ml/(kg.h),the incidence of postoperative AKI was 4.76%;the Intraoperative infusion volume was 5-7ml/(kg.h),the incidence of postoperative AKI was 1.38%;the Intraoperative infusion volume was >7 ml/(kg.h),the incidence of postoperative AKI was 1.95%;and compared with the intraoperative infusion volume of 5-7ml/(kg.h),the Intraoperative infusion volume of <5 ml/(kg.h)and >7 ml/(kg.h)increased the incidence of postoperative AKI;among them,the Intraoperative infusion volume of <5ml/(kg.h)had four times the odds of postoperative AKI compared to the intraoperative infusion volume of 5-7ml/(kg.h)(adjusted odds ratio 4.368,95%confidence interval 1.541-12.382).In elderly patients(≥65 years and older),Intraoperative hypotension is an independent risk factor for AKI after laparoscopic gastric and colorectal malignancies surgery.Patients with Intraoperative hypotension had two point seven times the odds of postoperative AKI compared to patients without Intraoperative hypotension(adjusted odds ratio 2.696,95% confidence interval 1.074-6.764).The Intraoperative infusion volume still showed a u-shaped relationship with the incidence of postoperative AKI,among them,the Intraoperative infusion volume of less than 5ml/(kg.h)had seven times the odds of postoperative AKI compared to the intraoperative infusion volume of 5-7ml/(kg.h)(adjusted odds ratio 7.005,95% confidence interval 1.730-28.365).Conclusions: This study found that aging and improper Intraoperative fluid management increased the risk of postoperative AKI.The Intraoperative infusion volume showed a u-shaped relationship with the incidence of postoperative AKI;the Intraoperative infusion volume of 5-7ml/(kg.h)is the most suitable.Avoiding Intraoperative hypotension and moderate Intraoperative infusion volume could reduce the incidence of postoperative AKI in elderly patients. |
