Intensive Care Medicine

, Volume 42, Issue 4, pp 521–530 | Cite as

Incidence and associations of acute kidney injury after major abdominal surgery

  • M. E. O’Connor
  • C. J. Kirwan
  • R. M. Pearse
  • J. R. ProwleEmail author
Systematic Review



Acute kidney injury (AKI) is a recognised risk factor for adverse outcomes in critical illness and hospitalised patients in general. To understand the incidence and associations of AKI as a peri-operative complication of major abdominal surgery, we conducted a systematic literature review and meta-analysis.


Using a systematic strategy, we searched the electronic reference databases for articles describing post-operative renal outcomes using consensus criteria for AKI diagnosis (RIFLE, AKIN or KDIGO) in the setting of major abdominal surgery. Pooled incidence of AKI and, where reported, pooled relative risk of death after post-operative AKI were estimated using random effects models.


From 4287 screened titles, 19 articles met our inclusion criteria describing AKI outcomes in 82,514 patients undergoing abdominal surgery. Pooled incidence of AKI was 13.4 % (95 % CI 10.9–16.4 %). In eight studies that reported the short-term mortality, relative risk of death in the presence of post-operative AKI was 12.6 fold (95 % CI, 6.8–23.4). Where reported, length of stay was greater and non-renal post-operative complications were also more frequent in patients experiencing AKI.


Using modern consensus definitions, AKI is a common complication of major abdominal surgery that is associated with adverse patient outcomes including death. While a causative role for AKI cannot be concluded from this analysis, as an important signal of peri-operative harm, AKI should be regarded as an important surgical outcome measure and potential target for clinical interventions.


Acute kidney injury Incidence Abdominal surgery Perioperative Systematic review 



MO’C is a National Institute for Health Research (NIHR) Academic Clinical Fellow in Intensive Care Medicine. RMP is the recipient of an NIHR Research Professorship.

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to declare.

Supplementary material

134_2015_4157_MOESM1_ESM.docx (339 kb)
Supplementary material 1 (DOCX 339 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  1. 1.Adult Critical Care UnitThe Royal London Hospital, Barts Health NHS TrustLondonUK
  2. 2.William Harvey Institute, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
  3. 3.Department of Renal Medicine and TransplantationThe Royal London Hospital, Barts Health NHS TrustLondonUK

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