Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis

Study Type: Retrospective observational study in a large North American paediatric centre.

Methods: Retrospective assessment for postoperative acute kidney injury (AKI) in patients ≤ 18 years of age having noncardiac surgery between 2013 & 2018 and having had a preoperative serum creatinine level in the previous 12 months.

Findings: A total of 25,203 surgical cases were identified. A little more than a third (8.924) were included in the study. The prevalence of AKI was 3.2% (95% CI: 2.9-3.6). Only ASA status, and not intraoperative hypotension, was associated with AKI on multivariate analysis. Hazard ratios for mortality (3.28 [1.71-6.32]) and readmission by 30 days (1.55 [1.08-2.23]) were significantly increased in patients with AKI when compared to those without.


This study confirms that AKI in paediatric surgery, whilst not as common as in adults, occurs frequently. Intraoperative hypotension is not significantly associated, which may or may not reflect reality. This study is useful as it is a large cohort pulled from a known, reliable, electronic record database. The obvious limitation is the potential for bias. Notably, patients having had bloods over the previous 12 months may well be different to the two thirds of all surgical patients who had no serum creatinine and were not included in the study. As such, the reported prevalence of AKI may be an overestimation. That said, it is useful to be able to put a number on our expectations of AKI rates in specialised paediatric surgical centres in wealthy countries.

Reviewed by Dr. Chris Brasher