Optimizing Perioperative Fluid Management in Complex Abdominal Wall Reconstruction to Prevent Postoperative Acute Kidney Injury

Abstract

Background Acute kidney injury (AKI) is a serious postoperative complication of abdominal wall reconstruction that can significantly impact outcomes of these patients. This study examines AKI following abdominal wall hernia repair to determine incidence and risk factors and outline potential mitigation strategies. Methods Using a single institution IRB-approved prospective database, patients undergoing complex abdominal wall reconstruction from 2013 to 2021 were identified. Patients with AKI were compared to controls and preoperative and intraoperative characteristics were evaluated. Multivariate analysis was utilized to identify factors associated with development of AKI. Results 297 patients were reviewed, 21.2 % (n = 63 patients) had AKI. Patients with AKI had a greater decrease in postoperative GFR to preoperative GFR (40.5% vs 18.3%, p <0.0001). Factors associated with AKI included ASA score >2 (odds ratio (OR) = 2.10, [1.50; 5.12], p = 0.02), HTN (OR = 2.05, [1.05; 4.0], p = 0.04), higher baseline Cr (OR = 5.98, [2.56; 13.98], p <0.0001), and diabetes (OR = 0.135, [0.0275; 0.666], p = 0.01). Operative time was longer in patients who developed AKI [average 400 min (range: 278-510 min) vs 310 min (range: 260-374 min), p = 0.04] and was an independent predictor of developing AKI (OR = 319.59, [137.25; 744.65], p <0.0001). Discussion Preoperative identification of patients with medical comorbidities undergoing elective complex abdominal wall reconstruction continues to be imperative to improve outcomes. This study demonstrates that perioperative management for high risk patients requires flexibility, including potential adjustments to enhanced recovery after surgery protocols in order to adequately address the risks for AKI.

The predictive values of monocyte–lymphocyte ratio in postoperative acute kidney injury and prognosis of patients with Stanford type A aortic dissection

“…reported that strict blood glucose control by an artificial endocrine pancreas during hepatectomy could prevent pAKI ( 42 ); Shelby et al. suggested that optimizing perioperative fluid management in patients who underwent complex abdominal wall reconstruction could prevent pAKI ( 43 ). However, more effective strategies to protect patients who underwent TAAD surgery from pAKI need further exploration.…”

“…A prospective randomized controlled study conducted by Kamenshchikov et al demonstrated that nitric oxide delivery during cardiopulmonary bypass reduced pAKI (41). In terms of non-cardiac surgery, Mita et al reported that strict blood glucose control by an artificial endocrine pancreas during hepatectomy could prevent pAKI (42); Shelby et al suggested that optimizing perioperative fluid management in patients who underwent complex abdominal wall reconstruction could prevent pAKI (43). However, more effective strategies to protect patients who underwent TAAD surgery from pAKI need further exploration.…”

Assessing the Influence of Intraoperative Core Body Temperature on Postoperative Venous Thromboembolism after Abdominal Wall Reconstruction

“…In those with postoperative acute kidney injury (as defined by the Risk, Injury, Failure, Loss, and End-stage Kidney criteria), 5000 units of unfractionated heparin three times a day was used instead. 16 Patients were required to ambulate with assistance at least once on POD 0 and then required to ambulate with assistance five or more times each day thereafter. Dedicated physical therapy was ordered only in cases of baseline mobility issues.…”