Analysis of risk factors of postoperative acute kidney injury in elderly patients with intertrochanteric fractures / 国际外科学杂志

ABSTRACT

Objective:To investigate the risk factors of postoperative acute kidney injury (AKI) in the elderly patients with intertrochanteric fractures.Methods:The clinical data of elderly patients who underwent surgery for intertrochanteric fractures in Second Affiliated Hospital of Chongqing Medical University from July 2018 to December 2022 were retrospectively analyzed, which was divided into AKI group and non-AKI group according to whether AKI occurred after surgery, with 33 cases in the AKI group and 274 cases in the non-AKI group. The data from two groups of patients including age, gender, body mass index, underlying diseases, Charlson comorbidity index(CCI), pre- and postoperative related laboratory indicators, American Society of Anesthesiologists classification, anesthesia and surgical methods, operation time, intraoperative hypotension, blood transfusion, perioperative medication and other electronic case data were compared. Measurement data with normal distribution were represented as the mean±standard deviation ( ± s), and comparison between groups was conducted using t-test. The measurement data of non-normal distribution were expressed by median (interquartile range) [ M( Q1, Q3)], and the Mann-Whitney U test was used for comparison between groups. Comparison between groups of count data was conducted using the Chi-square test or Fisher exact test. Univariate analysis was conducted on the pertinent indicators of the two groups, and the indicators with statistically significant were chosen for incorporation into the multivariate Logistic regression analysis to investigate the independent risk factors for postoperative AKI. Results:The incidence of postoperative AKI was 10.75% in elderly patients with intertrochanteric fractures. Results of the univariate analysis showed that there were significant differences between the two groups in diabetes mellitus, chronic kidney disease, CCI ≥2, baseline serum creatinine, preoperative blood urea nitrogen, preoperative estimated glomerular filtration rate, preoperative and early postoperative serum albumin levels, intraoperative hypotension, and perioperative blood transfusion( P<0.05). Results of multivariate Logistic regression analysis showed that CCI ≥ 2 ( OR =3.231, 95% CI 1.150-9.074, P =0.026) and intraoperative hypotension ( OR =4.617, 95% CI 1.746-12.205, P=0.002) were associated with the occurrence of AKI after intertrochanteric fracture surgery. Conclusion:CCI≥2 and intraoperative hypotension are independent risk factors of postoperative AKI in the elderly patients with intertrochanteric fractures.