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Findings In a cohort study of adults in Japan, the incidence of postoperative acute kidney injury increased as scores on the SPARK index increased. Meaning These findings suggest that it is difficult to precisely predict the probability of acute kidney injury preoperatively in noncardiac surgery, which includes various surgical procedures and participants with various medical backgrounds.

External validation has not been performed. Design, Setting, and Participants This single-center retrospective cohort study included adults who underwent noncardiac surgery under general anesthesia from to The study was conducted at Nara Medical University Hospital. Data analysis was conducted from January to July The discrimination and calibration of the SPARK index were examined with area under the receiver operating characteristic curves AUC and calibration plots, respectively.

Results Among participants [ For example, 10 of participants 1. Older age, diabetes, expected surgical duration, emergency surgery, renin-angiotensin-aldosterone system blockade use, and hyponatremia were not associated with PO-AKI in our cohort, resulting in overestimation of the predicted probability of AKI in our cohort.

However, the predicted probability might not be accurate in cohorts with older patients with more comorbidities. Postoperative acute kidney injury PO-AKI is a serious complication of surgical procedures that is associated not only with short-term increase in the risk of mortality 1 - 3 but also with long-term mortality. Preoperative risk stratification is useful for planning risk-based monitoring and management strategies to prevent PO-AKI and AKI-related death or dialysis.