ObjectiveTo investigate the prognosis and impact of postoperative acute kidney injury (AKI) on patients with acute Stanford type A aortic dissection (ATAAD), and to analyze the predictors for short- and medium-term survival. MethodsClinical data of patients who underwent ATAAD surgery in Qingdao Municipal Hospital from May 2014 to May 2019 were retrospectively analyzed. All discharged patients underwent telephone or outpatient follow-up, and were divided into an AKI group and a non-AKI group based on whether AKI occurred after surgery. The impact of postoperative AKI on the short- and medium-term prognosis was analyzed, and multivariate Cox analysis was used to screen the risk factors for short- and medium-term mortality. ResultsA total of 192 patients were collected, including 139 males and 53 females, with an average age of 53.3±11.4 years. Postoperative AKI was identified in 43 (22.4%) patients. The average follow-up time of discharged patients was 23.4±2.4 months, and the lost rate was 5.1%. The two-year survival rate after discharge of the AKI group was 88.2%, and that of the non-AKI group was 97.2%. Kaplan-Meier survival analysis and log-rank test showed that there was a statistical difference between the two groups (χ2=5.355, log-rank P=0.021). Multivariate Cox analysis results showed that age (HR=1.070, 95%CI 1.026 to 1.116, P=0.002), cardiopulmonary bypass time (HR=1.026, 95%CI 1.003 to 1.050, P=0.026), postoperative AKI (HR=3.681, 95%CI 1.579 to 8.582, P=0.003), transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively (HR=1.548, 95%CI 1.183 to 2.026, P=0.001) were independent risk factors for the short- and medium-term mortality of ATAAD patients. ConclusionThe incidence of postoperative AKI is high in ATAAD patients, and the mortality of patients with AKI increases significantly within two years. Age, cardiopulmonary bypass time and transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively are also independent risk factors for short- and medium-term prognosis.