Predictive factors of acute kidney injury in patients undergoing rectal surgery.
BACKGROUND
Despite major advance in surgical techniques from open surgery to robot-assisted surgery, acute kidney injury (AKI) is still major postoperative complication in rectal surgery. The purpose of this study is to compare the incidence of postoperative AKI according to different surgical techniques and also the risk factors, outcomes of AKI in patients undergoing rectal cancer surgery.


METHODS
A retrospective medical chart review was done in a total of 288 patients who received proctectomy because of rectal cancer from 2011 to 2013.


RESULTS
The mean patient age was 62 ± 12 years, and male was 64.2%. Preoperative creatinine was 0.91 ± 0.18 mg/dL. Open surgery was performed in 9%, and laparoscopy assisted surgery or robot assisted surgery were performed in 54.8% or 36.1% of patients, respectively. AKI developed in 11 patients (3.82%), 2 (18%) of them received acute hemodialysis. Incidence of AKI was not different according to the surgical technique, however, the presence of diabetes, intraoperative shock, and postoperative ileus was associated with the development of AKI. In addition, AKI patients showed significantly longer hospital stay and higher mortality than non-AKI patients.


CONCLUSIONS
Our study demonstrated that despite advances in surgical techniques, incidence of postoperative AKI remains unchanged and also that postoperative AKI is associated with poor outcome. We also found that presence of diabetes, intraoperative shock and postoperative ileus are strongly associated with the development of AKI. More careful attention should be paid on high risk patients for the development of postoperative AKI regardless of surgical techniques.
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Sung Yoon
SY
Lim
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Joon Yong
JY
Lee
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Ji Hyun
JH
Yang
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Young Joo
YJ
Na
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Myung-Gyu
MG
Kim
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Sang-Kyung
SK
Jo
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
Won Yong
WY
Cho
Acute kidney injury; Ileus; Laparoscopy; Proctectomy; Robotic surgical procedures
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