Abstract:
Introduction: Post-operative acute kidney injury (AKI) is a common complication following vascular surgery and is associated with poorer outcomes and longer hospital stay. The VSKIPS tool includes the following predictors for AKI: older age, reduced estimated glomerular filtration rate (eGFR), emergency surgery, preoperative diuretics and beta-blockers, previous vascular intervention, and hypertension. This study aimed to validate VSKIPS in our local population and to identify any additional risk factors to enhance preoperative assessment and improve patient outcomes.
Methods: We conducted a retrospective cohort study of 100 randomly selected vascular surgery patients. Patients were grouped post-operatively into 50 who developed AKI stage ≥2 and 50 who did not. Baseline characteristics were similar between groups. Data were extracted from electronic health records. Statistical analysis was performed using SPSS. Chi-squared and independent-samples t-tests were used for group comparisons.
Results: Diabetes mellitus, emergency surgery, perioperative beta-blocker use, and lower perioperative
eGFR were significantly associated with post-operative AKI in our cohort (all P<0.001). In contrast, older age (P=0.80), hypertension (P=0.069), nephrotoxic drug exposure (P=0.41), and prior vascular procedures (P=0.78) were not statistically significant, differing from the original VSKIPS study. These findings suggest diabetes may be an important additional independent risk factor in our patient population.
Conclusion: Our study validates key components of VSKIPS related to urgency of surgery, perioperative renal function, and beta-blocker use, and identifies diabetes as a major additional risk factor for AKI. Enhanced preoperative risk stratification, optimisation of modifiable risk factors, and a multidisciplinary perioperative approach are recommended to reduce AKI in vascular surgical patients.
