Acute kidney injury following spinal instrumentation surgery in children

Incidence and predictors of acute kidney injury after elective surgery for lumbar degenerative disease: A 13-year analysis of the US Nationwide Inpatient Sample

BACKGROUND

Acute kidney injury (AKI) is a severe postoperative complication associated with poor clinical outcomes, including the development of chronic kidney disease (CKD) and death. This study aimed to investigate the incidence and determinants of AKI following elective surgeries for degenerative lumbar spine disease.

METHODS

All patient data were extracted from the US Nationwide Inpatient Sample database. After surgery, AKI's incidence and risk factors were identified for lumbar degenerative disease. ICD-9 and ICD-10 codes defined lumbar spine degenerative disease, fusion, decompression, and AKI. The study cohort was categorized by type of surgery, that is, decompression alone or spinal fusion. Regression analysis was used to identify associations between AKI and risk factors organized by surgery type.

RESULTS

The incidence of AKI after decompression or fusion was 1.1% and 1.8%, respectively. However, the incidence of AKI in the United States is rising. The strongest predictor of AKI was underlying CKD, which was associated with an 9.0- to 12.9-fold more significant risk of AKI than in subjects without comorbid CKD. In this setting, older age, congestive heart failure, anemia, obesity, coagulopathy and hospital-acquired infections were also strong predictors of AKI. In contrast, long-term aspirin/anticoagulant usage was associated with lowered AKI risk.

CONCLUSION

Findings of this study inform risk stratification for AKI and may help to optimize treatment decisions and care planning after elective surgery for lumbar degenerative disease.

Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review

Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.

Incidence of and factors associated with acute kidney injury after scoliosis surgery in pediatric patients

PURPOSE

We sought to identify the national incidence of acute kidney injury (AKI) associated with pediatric posterior spinal fusion (PSF) surgery for scoliosis, and to determine factors that increase risk.

METHODS

The 1998-2014 National Inpatient Sample (NIS), a large United States hospital discharge database, was queried for discharges aged 0-17 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for scoliosis undergoing PSF for the outcome of AKI. Discharges were divided into those with AKI and unaffected. We fit adjusted logistic regression models to yield point estimates, odds ratios, 95% confidence intervals, and p values for the weighted, national population sample with postulated risk factors. The fit of the multivariable regression model was tested using the Hosmer-Lemeshow test, and collinearity using the variance inflation factor.

RESULTS

The NIS contained 103,270 weighted discharges meeting inclusion criteria. AKI incidence was 0.1%. Multivariable logistic regression model showed significantly increased odds ratios with thrombocytopenia, rhabdomyolysis, chronic kidney disease, abnormal coagulation, and male sex. AKI increased both hospital stay and cost by threefold compared to unaffected children.

CONCLUSION

This study suggests that AKI after pediatric PSF is rare. It is associated with abnormal coagulation, chronic kidney disease, and rhabdomyolysis, but not with the number of vertebral levels fused. Female sex appears to be protective. The retrospective nature of study and reliance on ICD-9-CM codes may under-represent the incidence of AKI in pediatric PSF patients.

[Progress in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery]

OBJECTIVE

To review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery.

METHODS

Regular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years.

RESULTS

As for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently.

CONCLUSION

Heretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.

Epidemiological characteristics of and risk factors for patients with postoperative acute kidney injury: a multicenter prospective study in 30 Chinese intensive care units

BACKGROUND

Although there were studies to investigate the risk factors for acute kidney injury (AKI) after surgery, most of them focused on one specific type of surgeries. The risk factors for postoperative AKI in patients undergoing all surgeries in intensive care units (ICU) have not been reported.

METHODS

Data from 1731 patients undergoing surgery in 30 ICUs of 28 tertiary hospitals in Beijing from March to August 2012 were prospectively collected. AKI was defined and staged by the KDIGO criteria. Multivariate logistic regression analysis was performed to assess independent risk factors for postoperative AKI.

RESULTS

Postoperative AKI occurred in 44.8% of patients (stage 1 54.8%; stage 2 21.9%, stage 3 23.3%). Cardiovascular surgery was identified as an independent factor for postoperative AKI as well as emergency surgery [odds ratio (OR) 1.403], nephrotoxic drugs (OR 1.303), APACHE II score (OR 1.055), SOFA score (OR 1.115), duration for positive fluid balance (OR 1.165), use of diuretics (OR 2.293), sepsis (OR 1.501), and CKD (OR 4.517). AKI stage 3 versus stages 1-2 was associated with higher mortality in ICU, hospital, and 28-day follow-up after cardiovascular, abdominal, limb, and chest surgeries, while this was not observed after neurosurgery or other surgeries.

CONCLUSION

Risk factors for AKI in ICU patients after different types of surgery were identified. This might be the first step to reduce the high incidence of AKI after surgery. The presence of AKI in ICU patients was associated with higher mortality after most types of surgery, but not after neurosurgery.

TRIAL REGISTRATION

ChiCTR-ONC-11001875.