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International Young Surgeons Competition

IYSC09 - Acute kidney injury and aorta-related mortality during open surgery of the abdominal aorta with suprarenal clamping using different renal perfusion solutions.

Friday, June 21, 2024
4:26 PM – 4:33 PM CT
Location: West Building, Level 1, W184bc
Objectives: Acute kidney injury (AKI) is the most frequent complication during open surgical repair (OSR) of abdominal aortic aneurysm (AAA) requiring suprarenal clamping, being also a potential marker of increased mortality in the short term. Currently, there are no experiences comparing nephroprotection strategies during OSR requiring suprarenal clamping. We aimed to evaluate the AKI incidence and outcomes in a cohort of patients who underwent OSR for AAA with suprarenal clamping comparing different renal perfusion solutions.

Methods: It is a physician-initiated, multicenter, retrospective observational study. For this study, all patients treated with OSR for AAA between January 1st 2015 and December 31st 2021 have been identified. Final analysis did not include patients already on dialysis. Collected data included estimate of renal function through creatinine and estimated glomerular filtration rate (eGFR). Primary outcomes have been early (≤30 days) AKI and aorta-related mortality (ARM). Secondary outcome was the need for dialysis (≤1 year).

Results: We analyzed 432 consecutive patients: 374 (86.6%) males and 58 (13.4%) females. The median of age was 73 years (IQR, 67-78). We repaired 289 (66.9%) juxtarenal AAA, and 143 (33.1%) pararenal AAA; urgent intervention was performed in 105 (24.3%) for rupture. Renal clamping was single renal in 124 (28.7%) cases, bilateral in 308 (71.3%). Most (n = 297, 68.7%) of the patients did not receive renal perfusion, ringer acetate was used in 83 (19.2%), and Custodiol in 52 (12.0%). Overall, AKI was observed in 149 (34.5%) patients: at binary logistic regression analysis, AKI was not influenced by renal perfusion solution (P = 0.797), but was associated with increased renal clamp time (OR: 1.02, 95%CI: 1.00-1.01, P = 0.011) and total clamp time (OR: 1.02, 95%CI: 1.01-1.04, P = 0.011). Overall, ARM occurred in 12 (2.8%) patients: predictors of ARM have been urgency (OR: 2.43, 95%CI: 1.10-5.35, P = 0.027), age (OR: 1.11, 95%CI: 1.03-1.21, P = 0.008), total intervention time (OR: 1.02, 95%CI: 1.00-1.05, P = 0.011), and the need of dialysis (OR: 1.01, 95%CI: 1.00-1.01, P = 0.001). The need of dialysis (n = 31, 7.2%) has been associated with preoperative chronic kidney disease (OR: 1.3.14, 95%CI: 1.35-7.34, P = 0.008), and urgency (OR: 6.74, 95%CI: 2.92-15.54, P < 0.001).

Conclusions: The risk of AKI is independent of the type of renal perfusion solution; both urgency and duration of cross-clamp time were associated with AKI and ARM.