Purpose:We conducted a retrospective cohort study to determine incidences of transient and persistent acute kidney injury (AKI) after major abdominal surgery and their impacts on long-term outcome. Materials and Methods:We enrolled 3,751 patients undergoing major abdominal surgery.Postoperative AKI was classified as transient or persistent based on the return of serum creatinine to the non-AKI range within 7 days post-surgery. Primary outcome was mortality within 1 year. We used multivariable Cox proportional hazard regression analysis to assess independent associations between AKI type and mortality.Results: Most patients with AKI were classified as transient (84%). Compared to patients without AKI, both patients with transient and persistent AKI demonstrated elevated 1-year mortality rates [adjusted hazard ratio (95% confidence interval): 2.01 (1.34-2.93); P = 0.001, and 6.20 (3.00-11.43); P < 0.001, respectively] and greater risk of chronic kidney disease progression at 1 year [adjusted odds ratio (95% confidence interval): 3.87 (2.12-7.08) and 23.70 (9.64-58.22), respectively; both P < 0.001]. Conclusions:Although most AKI cases after major abdominal surgery recover completely within 7 days, even these patients with transient AKI are at higher risk for 1-year mortality and chronic kidney disease progression compared to patients without AKI.

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Authors' Contributions Toshiyuki Mizota: This author conceptualized and designed the study, collected and analyzed the dataset, and drafted the manuscript. Li Dong: This author helped design the study, analyzed and interpreted data, and critically revised and approved the manuscript. Chikashi Takeda: This author helped design the study, analyzed and interpreted data, and critically revised and approved the manuscript. Atsuko Shiraki: This author analyzed and interpreted data and critically revised and approved the manuscript. Shino Matsukawa: This author analyzed and interpreted data and critically revised and approved the manuscript.

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Background Pain and discomfort during the awake phase in awake craniotomy should be relieved to facilitate brain mapping. Although some anaesthesiologists use low‐dose (0.01‐0.05 µg/kg/min) remifentanil infusion to provide analgesia during this phase, its efficacy and side effects have never been evaluated. Therefore, this study primarily aimed to investigate the effects of low‐dose remifentanil infusion on the need for antiemetic treatment during brain mapping and secondarily aimed to determine its effects on the need for additional analgesic treatment. Methods This retrospective study included 218 patients who underwent awake craniotomy at our centre from 2008 to 2018. The relationship between low‐dose remifentanil infusion during the awake phase and the requirement for analgesic or antiemetic treatment was examined. A multivariable competing risk regression analysis was performed to adjust for patient and operative variables. Results Sixty‐six patients (30.3%) received low‐dose (median rate: 0.01 µg/kg/min) remifentanil infusion during the awake phase. Forty‐nine patients (22.5%) received an antiemetic and 99 (45.4%) received additional analgesic treatment. The difference in additional analgesic treatment was not significant between patients who received low‐dose remifentanil infusion and those who did not (adjusted hazard ratio: 1.13; 95% confidence interval: 0.75‐1.70; P = .570); however, the use of antiemetics significantly increased in patients who received remifentanil (adjusted hazard ratio: 1.78; 95% confidence interval: 1.01‐3.15; P = .047). Conclusion Low‐dose remifentanil infusion during the awake phase in awake craniotomy significantly increased the need for antiemetics but did not decrease the need for additional analgesic treatment.