Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity. Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).

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Aim Fournier’s gangrene (FG) is a low‐incidence disease associated with high morbidity and mortality. The main objective of the present study was to analyse the impact of derivative colostomy (DC) on the course of FG. The secondary objective was to assess if DC recommendation should be immediate or delayed in the natural history of the disease, in order to reduce morbidity rates. Patients and Methods A prospective cohort of patients presenting with FG and treated at a single centre from 1996 to 2015 was studied. Patients who underwent DC were compared to those who did not (no‐DC group). Patients included in the DC group were subdivided into those who underwent colostomy during the initial surgery (immediate colostomy) and those with delayed colostomy. Results Forty‐six patients with FG were included. The DC group included 22 patients (48 per cent), and the no‐DC group included 24 patients (52 per cent). No differences were observed in hospital stay, the number of interventions or mortality rates. Patients with anorectal abscesses tended to undergo more derivative colostomies (55 per cent vs 8 per cent, P = 0.006). The subgroup with immediate colostomy had a higher mortality rate compared to the subgroup with deferred colostomy, although this was not statistically significant (37 per cent vs 14 per cent, P = 0.11). Conclusion DC in FG improves local disease control, but when performed during the initial surgery, it is associated with higher mortality.

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