title: Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study.
abstract: OBJECTIVE
  To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidney dysfunction.
  
  
  BACKGROUND
  More than 30% of patients older than 60 years are obese and, therefore, at risk for kidney disease. Postoperative AKI is a significant problem.
  
  
  METHODS
  We performed a matched case-control study of patients enrolled in the Obesity and Surgical Outcomes Study, using data of Medicare claims enriched with detailed chart review. Each AKI patient was matched with a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline estimated glomerular filtration rate, admission APACHE score, and the risk of death score with fine balance on hospitals.
  
  
  RESULTS
  We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (odds ratio = 1.65, P < 0.005) when compared with the nonobese patients. After adjustment for potential confounders, the odds of postoperative AKI remained elevated in the elderly obese (odds ratio = 1.68, P = 0.01.)
  
  
  CONCLUSIONS
  : Obesity is an independent risk factor for postoperative AKI in patients older than 65 years. Efforts to optimize kidney function preoperatively should be employed in this at-risk population along with keen monitoring and maintenance of intraoperative hemodynamics. When subtle reductions in urine output or a rising creatinine are observed postoperatively, timely clinical investigation is warranted to maximize renal recovery.
authors.affiliation: Departments of Surgery, The University of Pennsylvania, Philadelphia, PA 19104, USA. Rachel.Kelz@uphs.upenn.edu
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Reinke
authors.forename: José R
authors.initials: JR
authors.lastname: Zubizarreta
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.forename: Philip
authors.initials: P
authors.lastname: Saynisch
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D003082:Colectomy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013908:Thoracotomy