Frequency and Predictors of Acute Kidney Injury Following Major Abdominal Surgery: A Prospective Cross-Sectional Study from a Sudanese Tertiary Center

Frequency and Predictors of Acute Kidney Injury Following Major Abdominal Surgery: A Prospective Cross-Sectional Study from a Sudanese Tertiary Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frequency and Predictors of Acute Kidney Injury Following Major Abdominal Surgery: A Prospective Cross-Sectional Study from a Sudanese Tertiary Center Abdulrahman Ishag, Mohamed Elhaj Al-Awad, Mohammed Abbas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7775268/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Acute Kidney Injury (AKI) is a significant postoperative complication associated with increased morbidity and mortality. There is limited data on the epidemiology of acute kidney injury following general surgery in Sudan and the broader sub-Saharan African region. This study aimed to determine the frequency and identify the risk factors associated with AKI following major general surgery. Methods: A hospital-based, prospective cross-sectional study was conducted at Ibrahim Malik Teaching Hospital, Khartoum, Sudan, from November 2021 to February 2022. Consecutive adult patients (aged ≥18 years) undergoing major general surgery were enrolled. Patients with pre-existing renal disease were excluded. Data were collected using a structured questionnaire. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Data were analyzed using SPSS version 26.0. Results: Ninety-seven patients were included. The mean age was 40.6 ± 15.8 years, with a 1:1 male-to-female ratio. The overall frequency of postoperative AKI was 10.3% (n=10). AKI showed a significant statistical association with laparotomy (100% vs. 37.9%, p<0.001), intraoperative hypotension (100% vs. 5.7%, p<0.001), intraoperative massive bleeding (80.0% vs. 1.1%, p<0.001), emergency surgery (90.0% vs. 40.2%, p=0.003), and late postoperative recovery (30.0% vs. 1.1%, p<0.001). Pre-existing diabetes mellitus and hypertension were not significantly associated with AKI. Conclusion: The frequency of postoperative AKI is considerable. The type of surgery and intraoperative hemodynamic events were the strongest identifiable risk factors, suggesting that patients require meticulous intraoperative management. Acute Kidney Injury Postoperative Complications General Surgery Risk Factors Sudan Cross-Sectional Studies 1. Introduction Acute Kidney Injury (AKI), previously termed acute renal failure, is characterized by a sudden decline in kidney function and is a common and serious postoperative complication [ 1 ]. It is associated with prolonged hospital stays, increased healthcare costs, and a significant rise in morbidity and mortality [ 2 , 3 ]. The pathophysiology of postoperative AKI is multifactorial, involving renal hypoperfusion from hypotension or hemorrhage, inflammatory responses, ischemia-reperfusion injury, and exposure to nephrotoxic agents [ 4 ]. While well-studied in cardiac and vascular surgery populations, the risk profile for AKI following general surgery, particularly in resource-limited settings, is less defined [ 5 , 6 ]. In Sudan, there is a paucity of data on the epidemiology of postoperative AKI. Therefore, this study aimed to assess the frequency and identify the related risk factors of AKI following major general surgery at a tertiary teaching hospital in Khartoum, Sudan. 2. Methods 2.1. Study Design and Setting A prospective, cross-sectional, hospital-based study was conducted at Ibrahim Malik Teaching Hospital in Khartoum State, Sudan, from November 2021 to February 2022. 2.2. Study Population and Sampling The study enrolled consecutive adult patients (≥ 18 years) who underwent major general surgery. Patients with a known history of pre-existing renal disease were excluded. Informed written consent was obtained from all participants or their next of kin. 2.3. Data Collection Data were collected by the principal investigator using a comprehensive, pretested, structured questionnaire. The tool captured information on demographics, surgical details, intraoperative events, postoperative data, clinical information, and laboratory investigations, including preoperative and postoperative serum creatinine levels and electrolytes. 2.4. Definition of Outcome The primary outcome was the development of postoperative AKI, defined according to the KDIGO criteria as an increase in serum creatinine by ≥ 0.3 mg/dL (≥ 26.5 µmol/L) within 48 hours after surgery [ 9 ]. 2.5. Ethical Considerations Ethical approval was obtained from the Scientific Committee of the Internal Medicine Council at the Sudan Medical Specialization Board (SMSB) and the Research Unit at the EDC-SMSB. Permission was also secured from the Federal Ministry of Health and the hospital administration. Confidentiality was maintained. 2.6. Statistical Analysis Data were analyzed using SPSS version 26.0. Descriptive statistics were presented as frequencies, percentages, means, and standard deviations. Categorical variables were compared using the chi-square test or Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant. 3. Results 3.1. Baseline Characteristics A total of 97 patients were included. The mean age was 40.6 ± 15.8 years. More than half (53.6%) were under 40 years of age. The cohort had an equal gender distribution (49.5% male, 50.5% female). The vast majority of patients (88.7%) resided in Khartoum State, as shown in Table 1 . Table 1 Baseline Demographic Characteristics of the Study Participants (n = 97) Characteristic Category Frequency (n) Percentage (%) Age (years) 60 11 11.3 Gender Male 48 49.5 Female 49 50.5 Residence Khartoum 86 88.7 Other 11 11.3 3.2. Surgical and Perioperative Characteristics The most frequently performed surgical procedures were laparotomy (44.3%, n = 43) and cholecystectomy (38.1%, n = 37). Just over half of the operations (54.6%) were elective, while 45.4% were emergency procedures. All surgeries were performed under general anesthesia. The duration of surgery ranged from 1 to 3 hours, as indicated in Table 2 , which also shows a chi-square analysis for 52.6% of patients. Table 2 Surgical Characteristics of the Study Participants (n = 97) Characteristic Category Frequency (n) Percentage (%) Type of Surgery Laparotomy 43 44.3 Cholecystectomy 37 38.1 Appendectomy 9 9.3 Others 8 8.2 Type of Operation Elective 53 54.6 Emergency 44 45.4 Duration of Surgery (h) 3 27 27.8 3.3. Intraoperative and Postoperative Events Intraoperative hypotension was reported in 15.5% (n = 15) of cases, and massive bleeding occurred in 9.3% (n = 9). The vast majority of patients (95.9%) recovered immediately from anesthesia. Most patients (84.5%) were managed in the general ward after surgery, and 90.7% had adequate urine output (see Table 3 ). Table 3 Intraoperative and Postoperative Events (n = 97) Event Yes (n, %) No (n, %) Intraoperative Hypotension 15 (15.5%) 82 (84.5%) Intraoperative Massive Bleed 9 (9.3%) 88 (90.7%) Postoperative Recovery Immediate: 93 (95.9%) Late: 4 (4.1%) Postoperative Urine Output Adequate: 88 (90.7%) Decreased: 9 (9.3%) 3.4. Frequency and Factors Associated with AKI The frequency of postoperative AKI among the participants was 10.3% (n = 10). The analysis of factors associated with AKI is presented in Table 4 . The occurrence of AKI showed a highly significant statistical association with laparotomy, intraoperative hypotension, intraoperative massive bleeding, emergency surgery, and late postoperative recovery (p < 0.05 for all). There was no significant association between AKI and age, diabetes mellitus, or hypertension. Table 4 Factors Associated with Postoperative Acute Kidney Injury (n = 97) Factor AKI (n = 10) n (%) No AKI (n = 87) n (%) P-value Laparotomy 10 (100.0) 33 (37.9) < 0.001 Intraoperative Hypotension 10 (100.0) 5 (5.7) < 0.001 Intraoperative Massive Bleed 8 (80.0) 1 (1.1) < 0.001 Emergency Surgery 9 (90.0) 35 (40.2) 0.003 Late Recovery 3 (30.0) 1 (1.1) < 0.001 Diabetes Mellitus 1 (10.0) 10 (11.5) 0.888 Hypertension 1 (10.0) 9 (10.3) 0.973 4. Discussion This study found a considerable frequency (10.3%) of AKI following major general surgery. The key identified risk factors were the type of surgery (laparotomy), intraoperative events (hypotension and massive bleeding), and emergency operations. The strongest associations were with intraoperative events, consistent with global evidence [ 14 , 15 ]. Traditional patient-related comorbidities like diabetes and hypertension were not significant risk factors in this cohort. This finding could be attributed to the relatively young mean age (40.6 years) of our population, suggesting that the acute surgical and intraoperative insults may be the primary drivers of AKI in this setting. 4.1. Limitations The sample size is modest. The definition of intraoperative events was based on clinical notes rather than strict predefined thresholds. We relied on serum creatinine alone to define AKI, as urine output data was not consistently available. 5. Conclusion This study reveals that postoperative AKI is a common complication following major general surgery in Khartoum, Sudan. The most critical risk factors identified are modifiable intraoperative events, specifically hypotension and massive bleeding, often occurring during emergency laparotomies. These findings highlight a crucial opportunity for improving patient outcomes through implementing stricter intraoperative hemodynamic monitoring protocols and prompt management of blood loss. Abbreviations AKI Acute Kidney Injury aOR Adjusted Odds Ratio APACHE Acute Physiology and Chronic Health Evaluation ASA American Society of Anesthesiologists CI Confidence Interval CKD Chronic Kidney Disease eGFR Estimated Glomerular Filtration Rate HES Hydroxyethyl Starch IO Intestinal Obstruction KDIGO Kidney Disease Improving Global Outcomes MAP Mean Arterial Blood Pressure MD Mean Difference MNG Multinodular Goiter NSAIDs Non-Steroidal Anti-Inflammatory Drugs OR Odds Ratio SAPS Simplified Acute Physiology Score SPSS Statistical Package for Social Sciences Declarations Ethical considerations Written ethical clearance and approval for conducting this research were obtained from scientific committee of the Internal Medicine Council at the Sudan Medical Specialization Board. Written ethical clearance and approval for conducting this research were obtained from the ethical Committee of the research unit at the EDC in the Sudan Medical Specialization Board. Permission was obtained from the research committee at the Ministry of Health. Written permission was obtained from the administrative authority of Ibrahim Malik teaching hospital. A written consent was taken from the patients (if they can) or from their co patient Study data/information was used for the research purposes only. The confidentiality issues were intentionally considered. Privacy and confidentiality were maintained through coding of the data collection sheets. Consent for publication: All authors consent for publications. Availability of Data and materials : Data is not available in the moment, when it is available I will update. All Authors declare that the is NO competing interest This research has received no funding. Authors contributions: Dr: Abdulrahman Ishag: team and research supervisor. review data. Dr: Mohamed Elhaj Al-Awad: Data collection, participant consent Data analysis. Dr: Mohammed Abbas Manuscript writing and editing Corresponding author Author Contribution Dr: Abdulrahman Ishag:team and research supervisor.review data.Dr: Mohamed Elhaj Al-Awad:Data collection, participant consentData analysis.Dr: Mohammed AbbasManuscript writing and editingCorresponding author Data Availability Written ethical clearance and approval for conducting this research wereobtained from scientific committee of the Internal Medicine Council at theSudan Medical Specialization Board based on Helsinki Declaration- Written ethical clearance and approval for conducting this research wereobtained from the ethical Committee of the research unit at the EDC in theSudan Medical Specialization Board.- Permission was obtained from the research committee at the Ministry ofHealth.- Written permission was obtained from the administrative authority ofIbrahim Malik teaching hospital.- a consent was obtained from all participants the data is available References Kellum JA, et al. Crit Care Clin. 2015. Bihorac A, et al. Ann Surg. 2009. Long TE, et al. Anesth Analg. 2016. Wang Y, Bellomo R. Nat Rev Nephrol. 2017. Kheterpal S, et al. Anesthesiology. 2007. Kim M, et al. Anesth Analg. 2014. Chronopoulos A, et al. Nat Rev Nephrol. 2010. Gameiro J, et al. Ann Intensive Care. 2018. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012. Teixeira C, et al. Crit Care Res Pract. 2014. Rosa R, et al. Crit Care Res Pract. 2014. Causey MW, et al. J Surg Res. 2011. Wu XJ, et al. J Clin Anesth. 2017. Sun LY, et al. Anesthesiology. 2015. Walsh M, et al. Anesthesiology. 2013. Demarchi AC, et al. Ren Fail. 2014. Mikkelsen TB, et al. BMC Nephrol. 2022. Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eAcute Kidney Injury (AKI), previously termed acute renal failure, is characterized by a sudden decline in kidney function and is a common and serious postoperative complication [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with prolonged hospital stays, increased healthcare costs, and a significant rise in morbidity and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The pathophysiology of postoperative AKI is multifactorial, involving renal hypoperfusion from hypotension or hemorrhage, inflammatory responses, ischemia-reperfusion injury, and exposure to nephrotoxic agents [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While well-studied in cardiac and vascular surgery populations, the risk profile for AKI following general surgery, particularly in resource-limited settings, is less defined [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Sudan, there is a paucity of data on the epidemiology of postoperative AKI. Therefore, this study aimed to assess the frequency and identify the related risk factors of AKI following major general surgery at a tertiary teaching hospital in Khartoum, Sudan.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Setting\u003c/h2\u003e \u003cp\u003eA prospective, cross-sectional, hospital-based study was conducted at Ibrahim Malik Teaching Hospital in Khartoum State, Sudan, from November 2021 to February 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study Population and Sampling\u003c/h2\u003e \u003cp\u003eThe study enrolled consecutive adult patients (\u0026ge;\u0026thinsp;18 years) who underwent major general surgery. Patients with a known history of pre-existing renal disease were excluded. Informed written consent was obtained from all participants or their next of kin.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data Collection\u003c/h2\u003e \u003cp\u003eData were collected by the principal investigator using a comprehensive, pretested, structured questionnaire. The tool captured information on demographics, surgical details, intraoperative events, postoperative data, clinical information, and laboratory investigations, including preoperative and postoperative serum creatinine levels and electrolytes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Definition of Outcome\u003c/h2\u003e \u003cp\u003eThe primary outcome was the development of postoperative AKI, defined according to the KDIGO criteria as an increase in serum creatinine by \u0026ge;\u0026thinsp;0.3 mg/dL (\u0026ge;\u0026thinsp;26.5 \u0026micro;mol/L) within 48 hours after surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Ethical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Scientific Committee of the Internal Medicine Council at the Sudan Medical Specialization Board (SMSB) and the Research Unit at the EDC-SMSB. Permission was also secured from the Federal Ministry of Health and the hospital administration. Confidentiality was maintained.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 26.0. Descriptive statistics were presented as frequencies, percentages, means, and standard deviations. Categorical variables were compared using the chi-square test or Fisher\u0026rsquo;s exact test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Baseline Characteristics\u003c/h2\u003e \u003cp\u003eA total of 97 patients were included. The mean age was 40.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8 years. More than half (53.6%) were under 40 years of age. The cohort had an equal gender distribution (49.5% male, 50.5% female). The vast majority of patients (88.7%) resided in Khartoum State, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic Characteristics of the Study Participants (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhartoum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Surgical and Perioperative Characteristics\u003c/h2\u003e \u003cp\u003eThe most frequently performed surgical procedures were laparotomy (44.3%, n\u0026thinsp;=\u0026thinsp;43) and cholecystectomy (38.1%, n\u0026thinsp;=\u0026thinsp;37). Just over half of the operations (54.6%) were elective, while 45.4% were emergency procedures. All surgeries were performed under general anesthesia. The duration of surgery ranged from 1 to 3 hours, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which also shows a chi-square analysis for 52.6% of patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical Characteristics of the Study Participants (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAppendectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Operation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Surgery (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Intraoperative and Postoperative Events\u003c/h2\u003e \u003cp\u003eIntraoperative hypotension was reported in 15.5% (n\u0026thinsp;=\u0026thinsp;15) of cases, and massive bleeding occurred in 9.3% (n\u0026thinsp;=\u0026thinsp;9). The vast majority of patients (95.9%) recovered immediately from anesthesia. Most patients (84.5%) were managed in the general ward after surgery, and 90.7% had adequate urine output (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative and Postoperative Events (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Hypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (84.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Massive Bleed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (90.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediate: 93 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLate: 4 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Urine Output\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate: 88 (90.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased: 9 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Frequency and Factors Associated with AKI\u003c/h2\u003e \u003cp\u003eThe frequency of postoperative AKI among the participants was 10.3% (n\u0026thinsp;=\u0026thinsp;10). The analysis of factors associated with AKI is presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The occurrence of AKI showed a highly significant statistical association with laparotomy, intraoperative hypotension, intraoperative massive bleeding, emergency surgery, and late postoperative recovery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all). There was no significant association between AKI and age, diabetes mellitus, or hypertension.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors Associated with Postoperative Acute Kidney Injury (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAKI (n\u0026thinsp;=\u0026thinsp;10) n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo AKI (n\u0026thinsp;=\u0026thinsp;87) n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Hypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Massive Bleed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLate Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study found a considerable frequency (10.3%) of AKI following major general surgery. The key identified risk factors were the type of surgery (laparotomy), intraoperative events (hypotension and massive bleeding), and emergency operations. The strongest associations were with intraoperative events, consistent with global evidence [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Traditional patient-related comorbidities like diabetes and hypertension were not significant risk factors in this cohort. This finding could be attributed to the relatively young mean age (40.6 years) of our population, suggesting that the acute surgical and intraoperative insults may be the primary drivers of AKI in this setting.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Limitations\u003c/h2\u003e \u003cp\u003eThe sample size is modest. The definition of intraoperative events was based on clinical notes rather than strict predefined thresholds. We relied on serum creatinine alone to define AKI, as urine output data was not consistently available.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study reveals that postoperative AKI is a common complication following major general surgery in Khartoum, Sudan. The most critical risk factors identified are modifiable intraoperative events, specifically hypotension and massive bleeding, often occurring during emergency laparotomies. These findings highlight a crucial opportunity for improving patient outcomes through implementing stricter intraoperative hemodynamic monitoring protocols and prompt management of blood loss.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAKI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAcute Kidney Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eaOR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAPACHE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAcute Physiology and Chronic Health Evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eASA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eCI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eConfidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eCKD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eChronic Kidney Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eeGFR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eEstimated Glomerular Filtration Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eHES\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eHydroxyethyl Starch\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eIO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eIntestinal Obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eKDIGO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eKidney Disease Improving Global Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMAP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMean Arterial Blood Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMean Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMNG\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eMultinodular Goiter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eNSAIDs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eNon-Steroidal Anti-Inflammatory Drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eOR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eOdds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eSAPS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eSimplified Acute Physiology Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eSPSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWritten ethical clearance and approval for conducting this research were obtained from scientific committee of the Internal Medicine Council at the Sudan Medical Specialization Board.\u003c/li\u003e\n \u003cli\u003eWritten ethical clearance and approval for conducting this research were obtained from the ethical Committee of the research unit at the EDC in the Sudan Medical Specialization Board.\u003c/li\u003e\n \u003cli\u003ePermission was obtained from the research committee at the Ministry of Health.\u003c/li\u003e\n \u003cli\u003eWritten permission was obtained from the administrative authority of Ibrahim Malik teaching hospital.\u003c/li\u003e\n \u003cli\u003eA written consent was taken from the patients (if they can) or from their co patient\u003c/li\u003e\n \u003cli\u003eStudy data/information was used for the research purposes only. The confidentiality issues were intentionally considered.\u003c/li\u003e\n \u003cli\u003ePrivacy and confidentiality were maintained through coding of the data collection sheets.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors consent for publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and materials\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData is not available in the moment, when it is available I will update.\u003c/p\u003e\n\u003cp\u003eAll Authors declare that the is \u003cstrong\u003eNO competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis research has received no funding.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr: Abdulrahman Ishag: team and research supervisor. review data.\u003c/p\u003e\n\u003cp\u003eDr: Mohamed Elhaj Al-Awad:\u003c/p\u003e\n\u003cp\u003eData collection, participant consent\u003c/p\u003e\n\u003cp\u003eData analysis.\u003c/p\u003e\n\u003cp\u003eDr: Mohammed Abbas\u003c/p\u003e\n\u003cp\u003eManuscript writing and editing\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr: Abdulrahman Ishag:team and research supervisor.review data.Dr: Mohamed Elhaj Al-Awad:Data collection, participant consentData analysis.Dr: Mohammed AbbasManuscript writing and editingCorresponding author\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eWritten ethical clearance and approval for conducting this research wereobtained from scientific committee of the Internal Medicine Council at theSudan Medical Specialization Board based on Helsinki Declaration- Written ethical clearance and approval for conducting this research wereobtained from the ethical Committee of the research unit at the EDC in theSudan Medical Specialization Board.- Permission was obtained from the research committee at the Ministry ofHealth.- Written permission was obtained from the administrative authority ofIbrahim Malik teaching hospital.- a consent was obtained from all participants the data is available\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKellum JA, et al. Crit Care Clin. 2015.\u003c/li\u003e\n\u003cli\u003eBihorac A, et al. Ann Surg. 2009.\u003c/li\u003e\n\u003cli\u003eLong TE, et al. Anesth Analg. 2016.\u003c/li\u003e\n\u003cli\u003eWang Y, Bellomo R. Nat Rev Nephrol. 2017.\u003c/li\u003e\n\u003cli\u003eKheterpal S, et al. Anesthesiology. 2007.\u003c/li\u003e\n\u003cli\u003eKim M, et al. Anesth Analg. 2014.\u003c/li\u003e\n\u003cli\u003eChronopoulos A, et al. Nat Rev Nephrol. 2010.\u003c/li\u003e\n\u003cli\u003eGameiro J, et al. Ann Intensive Care. 2018.\u003c/li\u003e\n\u003cli\u003eKDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012.\u003c/li\u003e\n\u003cli\u003eTeixeira C, et al. Crit Care Res Pract. 2014.\u003c/li\u003e\n\u003cli\u003eRosa R, et al. Crit Care Res Pract. 2014.\u003c/li\u003e\n\u003cli\u003eCausey MW, et al. J Surg Res. 2011.\u003c/li\u003e\n\u003cli\u003eWu XJ, et al. J Clin Anesth. 2017.\u003c/li\u003e\n\u003cli\u003eSun LY, et al. Anesthesiology. 2015.\u003c/li\u003e\n\u003cli\u003eWalsh M, et al. Anesthesiology. 2013.\u003c/li\u003e\n\u003cli\u003eDemarchi AC, et al. Ren Fail. 2014.\u003c/li\u003e\n\u003cli\u003eMikkelsen TB, et al. BMC Nephrol. 2022.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute Kidney Injury, Postoperative Complications, General Surgery, Risk Factors, Sudan, Cross-Sectional Studies","lastPublishedDoi":"10.21203/rs.3.rs-7775268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7775268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Acute Kidney Injury (AKI) is a significant postoperative complication associated with increased morbidity and mortality. There is limited data on the epidemiology of acute kidney injury following general surgery in Sudan and the broader sub-Saharan African region. This study aimed to determine the frequency and identify the risk factors associated with AKI following major general surgery.\u003c/p\u003e\n\u003cp\u003eMethods: A hospital-based, prospective cross-sectional study was conducted at Ibrahim Malik Teaching Hospital, Khartoum, Sudan, from November 2021 to February 2022. Consecutive adult patients (aged ≥18 years) undergoing major general surgery were enrolled. Patients with pre-existing renal disease were excluded. Data were collected using a structured questionnaire. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Data were analyzed using SPSS version 26.0.\u003c/p\u003e\n\u003cp\u003eResults: Ninety-seven patients were included. The mean age was 40.6 ± 15.8 years, with a 1:1 male-to-female ratio. The overall frequency of postoperative AKI was 10.3% (n=10). AKI showed a significant statistical association with laparotomy (100% vs. 37.9%, p\u0026lt;0.001), intraoperative hypotension (100% vs. 5.7%, p\u0026lt;0.001), intraoperative massive bleeding (80.0% vs. 1.1%, p\u0026lt;0.001), emergency surgery (90.0% vs. 40.2%, p=0.003), and late postoperative recovery (30.0% vs. 1.1%, p\u0026lt;0.001). Pre-existing diabetes mellitus and hypertension were not significantly associated with AKI.\u003c/p\u003e\n\u003cp\u003eConclusion: The frequency of postoperative AKI is considerable. The type of surgery and intraoperative hemodynamic events were the strongest identifiable risk factors, suggesting that patients require meticulous intraoperative management.\u003c/p\u003e","manuscriptTitle":"Frequency and Predictors of Acute Kidney Injury Following Major Abdominal Surgery: A Prospective Cross-Sectional Study from a Sudanese Tertiary Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 10:21:49","doi":"10.21203/rs.3.rs-7775268/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"749e5216-32b4-4c8c-a163-6a2fae3113c0","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-12T16:11:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 10:21:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7775268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7775268","identity":"rs-7775268","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}