Etiology, prognosis, and outcome of post-operative acute renal failure

A Multivariate analysis was done in all patients who developed post operati ve ARF, during the period 1990-1995 to determine the etiological spectrum a nd to identify various variables affecting the outcome. Of 140 patients (11 0 operated at SGPGI and 30 operated outside) 116 underwent elective surgery . The different types of surgery leading to ARF were urosurgery (3.5%), ope n heart surgery (32.9%), gastrosurgery (16.4%), pancreatic surgery (9.3%), obstetrical surgery (3.6%) and others (2.8%). The incidence of ARF in SGPGI patients was highest in pancreatic surgery group (8.2%) followed by open h eart surgery (3%). The different etiological factors responsible for ARF we re perioperative hypotension (67.1%), sepsis (63.6%) and exposure to nephro toxic drugs (29.3%). Sixty-four patients (45.7%) required dialysis. The ove rall mortality was 45% The mortality was highest in patients who underwent open heart surgery (89.1%) followed by pancreatic surgery (84.6%). The fact ors associated with high mortality, other than the type of surgery, were pr eoperative hypotension (p < 0.05), oliguria (p < 0.01), need for dialysis ( p < 0.05) and multiorgan failure (p < 0.001). AM following emergency surger y had poor outcome, though not statistically significant. Perioperative sep sis (p < 0.05) and preoperative use of aminoglycoside (p < 0.05) were signi ficantly higher in patients operated outside SGPGI. This was associated wit h higher incidence of ARF. Thus we conclude that presence of multiorgan fai lure, oligoanuria, preoperative hypotension and need far dialysis are poor prognostic markers in ARF following surgery.