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

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.