Risk Factors for Acute Kidney Injury After Surgery for Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to evaluate risk factors for acute kidney injury (AKI) after surgery for Stanford type A aortic dissection. We searched Web of Science, PubMed, Embase, Proquest, Cochrane Library, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature databases from inception to January 2026. A total of 58 case-control studies were included, assessed using the Newcastle-Ottawa Scale. Meta-analysis identified numerous significant perioperative factors. Key demographic and preoperative risk factors included age, body mass index, hypertension history, preoperative renal insufficiency, elevated cystatin C, lactate, serum creatinine, white blood cell count, and renal malperfusion, while a higher left ventricular ejection fraction was protective. Intraoperative factors such as prolonged cardiopulmonary bypass time, increased red blood cell transfusion, and total aortic arch replacement increased AKI risk, whereas higher intraoperative urine output was protective. Postoperatively, prolonged mechanical ventilation and acute respiratory insufficiency were also high-risk factors. In conclusion, multiple preoperative, intraoperative, and postoperative factors significantly influence AKI risk following Stanford type A aortic dissection surgery. Comprehensive perioperative assessment of these factors may help clinicians implement targeted management to reduce AKI incidence and improve patient outcomes.