Early acute kidney injury is associated with extended length of stay and major complications after curative-intent hepatectomy.

Abstract

Acute kidney injury after abdominal surgery is associated with increased morbidity, but little is known about acute kidney injury after hepatectomy, which was the focus of our study. Patients undergoing curative-intent hepatectomy during 2017-2023 were included. Creatinine levels were collected within 2 weeks after hepatectomy. Acute kidney injury was defined as a creatinine level increase by ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline within 7 days; early acute kidney injury was defined as acute kidney injury by postoperative day 2. The study included 1,658 patients, of whom 180 (11%) had early acute kidney injury. Age >65 years, cardiovascular disease, diabetes mellitus, liver disease, kidney disease, longer operative time, and higher estimated blood loss were independently associated with an increased risk of early acute kidney injury. Median length of hospital stay was longer among patients with early acute kidney injury than among those without, for both low-risk (5 vs 3 days; P < .001) and high-risk hepatectomy (5 vs 4 days; P = .002). Patients with early acute kidney injury had a higher rate of major (Accordion ≥3) complications (22% vs 10%, P < .001). Multivariable analysis revealed 3 predictors of major complications: early acute kidney injury (odds ratio, 1.81; 95% confidence interval, 1.18-2.76), high-risk hepatectomy (odds ratio, 1.57; 95% confidence interval, 1.12-2.19), and operative time >7 hours (odds ratio, 2.66; 95% confidence interval, 1.90-3.73). The major complication rate was 6% for patients without the aforementioned factors, 13% for patients with 1 factor, and 33% for patients with all 3 factors. Early postoperative acute kidney injury is associated with extended hospital stay and predicts major complications, especially for patients with high-risk hepatectomy and extended operative time.