Early acute kidney injury (AKI) post-hepatic surgery significantly raises the risk of major complications and lengthens hospital stays, making careful monitoring essential.

• In a cohort of 1,658 patients, 11% developed early AKI by postoperative day 2, leading to a median hospital stay of 5 days compared to 3 days for those without AKI (p < .001).
• Patients with early AKI saw a major complication rate of 22%, double that of patients without AKI (10%, p < .001).
• Key predictors for major complications included early AKI (odds ratio 1.81), high-risk hepatectomy (1.57), and operative time exceeding 7 hours (2.66).

Surgeons should consider these factors when planning outcomes and managing postoperative care.