The impact of postoperative acute kidney injury on survival after surgery for type A aortic dissection repair: Results from over 6000 patients.
Xander Jacquemyn, Rohit Ganduboina, Michel Pompeu Sá et al.
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In 30 seconds
This systematic review and meta-analysis examined long-term survival after surgical repair of type A aortic dissection according to postoperative acute kidney injury (AKI) status. Nine studies comprising 6,608 patients were included, with individual patient data reconstructed from digitised Kaplan–Meier curves. AKI occurred in 35.6% of patients (95% CI 26.4-45.9%) and was associated with three-fold higher long-term mortality than no AKI (HR 3.00, 95% CI 2.59-3.49, p < 0.001). The excess risk was greatest in the first three months and increased with AKI severity.
Key findings
- One-year survival was 75% (95% CI 73-77) with AKI versus 93% (95% CI 92-94) without AKI.
- Ten-year survival was 52% (95% CI 47-58) with AKI versus 68% (95% CI 59-77) without AKI.
- Mortality risk was highest in the first 3 months (HR 4.72, 95% CI 3.82-5.83) and remained elevated thereafter (HR 1.74, 95% CI 1.41-2.15).
- Mortality risk rose with AKI stage: stage 1 HR 1.79, stage 2 HR 2.88, and stage 3 HR 5.06.
Why it matters
The findings indicate that postoperative AKI marks substantially poorer short- and long-term survival after type A dissection repair, with risk varying by AKI severity and persisting beyond the early postoperative period. This supports attention to renal outcomes as part of postoperative risk assessment and highlights the potential importance of follow-up after discharge.
What to keep in mind
The analysis combined nine studies, and survival data were reconstructed by digitising Kaplan–Meier curves rather than obtained from original individual patient records.