(1329) Incidence, Risk Factors, and Outcome of AKI in Adult Patients Undergoing Emergency Laparotomy

Introduction: AKI is seen in 5.0-7.5% of all in-hospital patients, and 40% of them are post-operative patients. Major abdominal surgeries account for 3.1-35% of cases of postoperative AKI in various series. However, there are increased chances of developing AKI following emergency laparotomy as most of the patients present with hypotension, volume depletion, and sepsis and are at risk development of AKI. Most of the emergency laparotomy are due to perforation peritonitis and a large proportion of these patients present with sepsis and multiorgan dysfunction with mortality around 15-17%. The aims of the study are to identify the incidence risk factors of postoperative AKI in peritonitis patients undergoing emergency laparotomy.

Methods: After institute ethics committee approval and informed written consent, adult patients 18-65 years of age undergoing emergency laparotomy were included in this prospective observational study. Baseline data, intraoperative details, and postoperative outcome data (AKI at day 7, length of ICU, and hospital stay and mortality) were noted. A logistic regression model was constructed to predict AKI on day 7. All statistical analyses were performed in SPSS (IBM Corp).

Results: Total 140 patients were included and 69 patients (49.3%) developed AKI within day 7. From the logistic regression model, we found that higher use of crystalloid [adjusted OR (95% CI) 1.00(1.00-1.00); p=0.012], intraoperative vasopressor use [OR 7.42 (2.414-22.83); p< 0.001], intraoperative blood loss [OR 1.004(1.00-1.01); p=0.003] and presence of chronic liver disease (CLD) [OR 22.442 (1.683-299.26); p=0.019] were risk factors for development of AKI. AKI patients had increased mortality (24.6% vs 1.4%; p< 0.001), length of ICU stay (3 days vs 0 days, p< 0.001), and length of hospital stay (11 days vs 7 days; p< 0.001).

Conclusions: In peritonitis patients undergoing emergency laparotomy, as many as 49% of patients develop AKI within one week. The presence of CLD, intraoperative blood loss, and the use of crystalloids and vasopressor increases the risk of AKI.