Failure of early creatinine recovery predicts poor survival after emergency surgery for bowel perforation or infarction

Abstract

Background: Early postoperative recovery of kidney function is critical in emergency bowel surgery. This study evaluated the prognostic value of preoperative creatinine elevation (PCE) and early creatinine recovery (ECR). Methods: A total of 424 patients underwent emergency surgery for bowel perforation or ischemia from January 2019 to December 2024. Sixteen trauma-related cases (including procedure-related injuries) were excluded, leaving 408 patients for analysis. Of these, 35 patients with end-stage renal disease or chronic kidney disease-either pre-existing or newly diagnosed during hospitalization-were excluded. ECR was defined as a decrease in serum creatinine to <1.3 mg/dl by postoperative day (POD) 3. PCE was defined as serum creatinine >1.3 mg/dl. Associations with postoperative complications and 30-day mortality were estimated using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs. Results: PCE occurred in 18.5% (69/373) of the tested patients; among these, 58.0% (40/69) achieved ECR by POD 3. Failure of ECR was associated with severe complications (93.1% vs. 27.5%, P<0.001) and higher mortality (72.4% vs. 7.5%, P<0.001). In multivariable analysis, ECR failure independently predicted complications (aOR, 28.71; 95% CI, 5.44-151.57) and 30-day mortality (aOR, 32.37; 95% CI, 7.74-135.40; P<0.001 for both), Conclusions: Failure to achieve ECR is independently associated with poor survival after emergency laparotomy for peritonitis. This finding supports the use of a creatinine-based checkpoint to trigger intensified monitoring and targeted rescue interventions.