BACKGROUND: Postoperative acute kidney injury (AKI) is a serious complication that is associated with prolonged hospital stay, high risk of short-term postsurgical mortality, need for dialysis, and possible progression to chronic kidney disease. To date, very little data exist on the risk of postoperative AKI among children undergoing noncardiac surgical procedures. We used data from a large multicenter cohort to determine the factors associated with AKI among children who underwent inpatient noncardiac surgical procedures and its impact on the postoperative course. METHODS: We utilized the National Surgical Quality Improvement Program Pediatric participant user files to identify a cohort of children who underwent inpatient surgery between 2012 and 2018 (n = 257,439). We randomly divided the study population into a derivation cohort of 193,082 (75%) and a validation cohort of 64,357 (25%), and constructed a multivariable logistic regression model to identify independent risk factors for AKI. We defined AKI as the occurrence of either acute renal failure or progressive renal insufficiency within the 30 days after surgery. RESULTS: The overall rate of postoperative AKI was 0.10% (95% confidence interval [CI], 0.09–0.11). In a multivariable model, operating times longer than 140 minutes, preexisting hematologic disorder, and preoperative sepsis were the strongest independent predictors of AKI. Other independent risk factors for AKI were American Society of Anesthesiologists (ASA) physical status ≥III, preoperative inotropic support, gastrointestinal disease, ventilator dependency, and corticosteroid use. The 30-day mortality rate was 10.1% in children who developed AKI and 0.19% in their counterparts without AKI (P < .001). Children who developed AKI were more likely to require an extended hospital stay (≥75th percentile of the study cohort) relative to their peers without AKI (77.4% vs 21.0%; P < .001). CONCLUSIONS: Independent preoperative risk factors for AKI in children undergoing inpatient noncardiac surgery were hematologic disorder, preoperative sepsis, ASA physical status ≥III, inotropic support, gastrointestinal disease, ventilator dependency, and steroid use. Children with AKI were 10 times more likely to die and nearly 3 times more likely to require an extended hospital stay, relative to their peers without AKI.

中文翻译：

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儿童非心脏手术后急性肾损伤的危险因素及后果

背景：术后急性肾损伤（AKI）是一种严重的并发症，与住院时间延长、术后短期死亡率高、需要透析以及可能进展为慢性肾病有关。迄今为止，关于接受非心脏手术的儿童术后 AKI 风险的数据很少。我们使用来自大型多中心队列的数据来确定在接受住院非心脏外科手术的儿童中与 AKI 相关的因素及其对术后病程的影响。方法：我们利用国家手术质量改进计划儿科参与者用户文件来确定 2012 年至 2018 年期间接受住院手术的一组儿童（n = 257,439）。我们将研究人群随机分为 193 人的派生队列，082 (75%) 和 64,357 (25%) 的验证队列，并构建了一个多变量逻辑回归模型来识别 AKI 的独立危险因素。我们将 AKI 定义为在手术后 30 天内发生急性肾功能衰竭或进行性肾功能不全。结果：术后 AKI 的总体发生率为 0.10%（95% 置信区间 [CI]，0.09-0.11）。在多变量模型中，手术时间超过 140 分钟、先前存在的血液系统疾病和术前败血症是 AKI 最强的独立预测因子。AKI 的其他独立危险因素包括美国麻醉医师协会 (ASA) 身体状况≥III、术前正性肌力支持、胃肠道疾病、呼吸机依赖和皮质类固醇使用。发生 AKI 和 0 的儿童 30 天死亡率为 10.1%。在没有 AKI 的同行中为 19% (P < .001)。与没有 AKI 的同龄人相比，发生 AKI 的儿童更可能需要延长住院时间（≥75% 的研究队列）（77.4% 对 21.0%；P < .001）。结论：接受住院非心脏手术的儿童发生 AKI 的独立术前危险因素是血液系统疾病、术前脓毒症、ASA 身体状况≥III、正性肌力支持、胃肠道疾病、呼吸机依赖和类固醇使用。与没有 AKI 的同龄人相比，患有 AKI 的儿童死亡的可能性高出 10 倍，需要延长住院时间的可能性高出近 3 倍。与没有 AKI 的同龄人相比，发生 AKI 的儿童更可能需要延长住院时间（≥75% 的研究队列）（77.4% 对 21.0%；P < .001）。结论：接受住院非心脏手术的儿童发生 AKI 的独立术前危险因素是血液系统疾病、术前脓毒症、ASA 身体状况≥III、正性肌力支持、胃肠道疾病、呼吸机依赖和类固醇使用。与没有 AKI 的同龄人相比，患有 AKI 的儿童死亡的可能性高出 10 倍，需要延长住院时间的可能性高出近 3 倍。与没有 AKI 的同龄人相比，发生 AKI 的儿童更可能需要延长住院时间（≥75% 的研究队列）（77.4% 对 21.0%；P < .001）。结论：接受住院非心脏手术的儿童发生 AKI 的独立术前危险因素是血液系统疾病、术前脓毒症、ASA 身体状况≥III、正性肌力支持、胃肠道疾病、呼吸机依赖和类固醇使用。与没有 AKI 的同龄人相比，患有 AKI 的儿童死亡的可能性高出 10 倍，需要延长住院时间的可能性高出近 3 倍。胃肠道疾病、呼吸机依赖和类固醇使用。与没有 AKI 的同龄人相比，患有 AKI 的儿童死亡的可能性高出 10 倍，需要延长住院时间的可能性高出近 3 倍。胃肠道疾病、呼吸机依赖和类固醇使用。与没有 AKI 的同龄人相比，患有 AKI 的儿童死亡的可能性高出 10 倍，需要延长住院时间的可能性高出近 3 倍。