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Acute kidney injury; Esophageal cancer surgery; Nested case-control study

Introduction

With incidences ranging from 5.1% to 35.3%, acute kidney injury (AKI) has been recognized as a serious complication of thoracic surgery. It has been linked to poor clinical outcomes and a prolonged hospital stay following surgery, according to reports [1]. As a result, if we can identify risk factors for AKI, we might be able to enhance perioperative management for AKI that has already developed. Different types of surgeries and definitions of AKI contribute to the wide range in postoperative AKI incidence. Three distinct AKI definition and classification systems have been developed and implemented in clinical practice to this point. The RIFLE (Risk, Injury, Failure, Loss) scale is currently used in studies about postoperative AKI incidence and risk in thoracic surgeries [2].

Method

Criteria for End-Stage Renal Disease (ESRD) and the Acute Kidney Injury Network (AKIN) However, little is known about the KDIGObased assessment of AKI incidence (Kidney Disease: The most recent definition of AKI, the Improving Global Outcomes) criteria, following thoracic surgery. In addition, while a small number of studies focused on patients undergoing esophageal surgery, the majority of trials attempted to address risk factors for AKI in patients undergoing lung resection. As a result, we conducted this retrospective nested case-control study to identify risk factors for the development of AKI postoperatively and to determine the incidence of AKI following esophageal cancer surgery using the KDIGO criteria [3].

We omitted patients from the elective esophageal cancer surgery group who required preoperative dialysis or had no data on the studied parameters. Cases were patients who experienced AKI after surgery, and controls were those who did not experience AKI after surgery during the follow-up period. We obtained baseline data, intraoperative variables, and matched controls for each case using incidence density sampling. For each case, four controls were identified and matched based on the same sex [4], similar age (5 years), and comparable date of surgery (matched control with the closest timestamp to corresponding case). The patient's age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status class, preoperative chemo radiotherapy, smoking history, comorbidities like systemic hypertension, diabetes mellitus, and coronary artery disease, and preoperative laboratory data were all part of the baseline information [5].

Blood glucose (GLU), blood urea nitrogen (BUN), serum creatinine (Cr), serum uric acid (UA), cholesterol (CHOL), triglyceride (TG), albumin (ALB), hemoglobin (Hb), hemoglobin hematocrit (Hct), and blood group were all measured in the laboratory. From the postoperative histology results, tumor histology and stage were also collected.

Result

Anesthetic method (generally alone or combined epidural anesthesia), duration of surgery, intraoperative hypotension, intraoperative hypoxemia, volume and type of fluids (crystalloid or colloid), transfusion of blood products like red blood cells (RBCs) and fresh frozen plasma (FFP), estimated blood loss during anesthesia, operation type (open or minimally invasive approach), method of surgery (Sweet, Ivor-Lewis, or Three-incision), and tumor location Electronic medical and anesthetic records were reviewed in reverse to discover all variables. According to the KDIGO criteria, a minimal increase of Cr of 0.3 mg/dl (26.5 mmol/l) within 48 hours indicates the presence of AKI. To determine whether postoperative AKI existed, a comparison was made between the highest postoperative Cr and the baseline. Postoperative Cr is the highest Cr level within the first 48 hours after surgery, while baseline Cr is the lowest Cr level [6]. The use of any vasopressor during the operation or the lowest systolic blood pressure less than 80 mmHg were used to determine intra-operative hypotension. Pulse oximetry was used to identify intraoperative hypoxemia as less than 90% arterial oxygen saturation [7].

Discussion

By carrying out the following, we intended to addr ess potential biascausing factors. All of the cases and matched controls belonged to the same cohort. In addition, to reduce bias caused by changes in standard clinical management during the study period, we matched cases and controls with comparable surgical dates. Finally, Wen Wang and Tong Wang, who were not involved in clinical management, obtained the variables. When we recruited the entire cohort for our study, this was not taken into account. Variables were compared between cases (patients with AKI, the AKI group) and controls (patients without AKI, the non-AKI group). Mean standard deviation (SD) was used for continuous variables, and frequency and percentage (n, %) were used for categorical variables. Taking into account the 1:4 matched set study design, univariate conditional logistic regression was used to compare variables between cases and controls.

In addition, independent risk factors for AKI were identified through multivariate conditional logistic regression analysis. Multivariate analysis included univariate variables with a P value of less than 0.1. We calculated odds ratios (OR) with confidence intervals (CI) of 95 percent. A two-tailed P value of less than 0.05 was deemed statistically significant by us. The SPSS software (Statistical Package for the Social Sciences, version 19.0, SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.

Between July 2013 and July 2016, a total of 2321 patients underwent esophageal surgery. Due to insufficient data, 227 of these patients were excluded from the study, while 2094 of them were included. Tables 1 and 2 show the characteristics of all 2094 patients. Based on the KDIGO criteria, 51 patients developed AKI postoperatively. In our study, the estimated prevalence of AKI is 2.4%.

Conclusion

In the end, we looked at 51 cases (patients with AKI) and 204 matched controls (patients without AKI). Table 1 displays the baseline characteristics of cases and controls. The majority were men, with a mean age of 63 years. Age and gender were excluded from our investigation due to matching criteria. For the most part, baseline characteristics did not differ significantly between cases and controls. When compared to controls, cases were more likely to have a higher UA (P 14 0.001), higher Cr (P 14 0.001), and larger BMI (P 14 0.010). 51.9 percent versus 18.6 percent of patients in the AKI group; P 0.001) had high blood pressure. Patients with AKI were more likely to have one or more comorbidities when assessed in combination (59 percent vs. 23 percent; P < 0.001). The cases' and controls' intraoperative variables are shown in Table 2. Crystalloid and colloid were administered intraoperatively to AKI patients more frequently than to non-AKI patients (P 14% 0.012). Patients with AKI had a significantly lower rate of intraoperative hypoxemia than patients without AKI (P 14 0.011). Ivor-Lewis and 3-incision surgeries were more common in AKI patients than in non-AKI patient. Surgery took significantly longer for AKI patients than it did for non-AKI patients.

By employing multivariate conditional logistic regression, we were able to identify distinct risk factors for the onset of AKI. Using both a statistical (univariate analysis with P 0.1) and clinical justification, the following variables were included in the multivariate analysis: BMI, smoking history, hypertension, number of preoperative comorbidities, preoperative BUN, Cr, UA, and ALB, length of surgery, intraoperative hypotension, hypoxemia, total crystalloid, and surgical procedure Four risk factors for acute kidney injury (AKI) following esophageal cancer surgery were identified through multivariate conditional logistic regression analysis. Postoperative acute kidney injury (AKI) incidence and risk factors in esophageal cancer surgery patients between 2013 and 2016 were the subject of our retrospective, single-center study. Overall, although postoperative acute kidney injury (AKI) in thoracic surgery has been the subject of numerous studies, little is known about AKI after esophageal surgery. Lee et al.'s research Using the AKI Network criteria, a 2014 study found that 35.3% of esophageal cancer surgeries resulted in postoperative AKI. Howevermost recent publication despite using the same AKI Network criteria, has demonstrated a significantly lower incidence of AKI after esophageal cancer surgery (11.9%). However, compared to the incidences of AKI in these two studies, the incidence of AKI following esophageal surgery in our study was 2.4% based on the KDIGO criteria. The use of different criteria to define AKI in different studies may partially account for the disparity in AKI incidence. Patient populations may provide an additional explanation. More than 80% of the people in our study had an ASA physical status of I-II, indicating a lower prevalence of comorbidities.

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