Impact of intraoperative hypotension on early postoperative acute kidney injury in cystectomy patients – A retrospective cohort analysis - 24/09/20
, Kaspar F. Bachmann, M.D. a , Marc A. Furrer, M.D. b , Patrick Y. Wuethrich, M.D. a Abstract |
Study objective |
To assess the risk for postoperative acute kidney injury (AKI) after major urologic surgery for different intraoperative hypotension thresholds in form of time below a fixed threshold. We hypothesize that the duration of hypotension below a certain hypotension threshold is a risk factor for AKI also in major urologic procedures.
Design |
Retrospective observational cohort series.
Setting |
Single tertiary high caseload center.
Patients |
416 consecutive patients undergoing open radical cystectomy, pelvic lymph node dissection and urinary diversion between 2013 and 2019.
Interventions |
None.
Measurements |
We analyzed intraoperative data and their correlation to postoperative AKI judged according to the Acute Kidney Injury Network criteria. Patients were divided into groups falling below MAP <65 mmHg, MAP <60 mmHg and MAP <55 mmHg. The probability of developing postoperative AKI using all risk variables as well as the hypotension threshold variables (minutes under a certain threshold) was calculated using logistic regression methods.
Main results |
Postoperative AKI was diagnosed in 128/416 patients (30.8%). Multiple logistic regression analysis showed that minutes below a threshold of 65 mmHg (OR 1.010 [1.005–1.015], P < 0.001) and 60 mmHg (OR 1.012 [1.001–1.023], P = 0.02) are associated with an increased risk of AKI. On average, 26.5% (MAP <65 mmHg), 50.0% (MAP <60 mmHg) and 76.5% (MAP <55 mmHg) of minutes below a certain threshold occurred between induction of anesthesia and start of surgery and are thus fully attributable to anesthesiological management.
Conclusions |
Our results suggest that avoiding intraoperative MAP lower than 65 mmHg and especially lower than 60 mmHg will protect postoperative renal function in cystectomy patients. The time between induction of anesthesia and surgical incision warrants special attention as a relevant share of hypotension occur in this period.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Hypotension has been associated with postoperative acute kidney injury (AKI). |
• | Urological procedures have been excluded from previous analyses. |
• | This study aimed to analyze AKI in patients undergoing major urological surgery. |
• | We show that hypotension below 65mmhg is associated with increased risk of AKI. |
Keywords : Arterial pressure, Hypotension, Intraoperative complications, Postoperative acute kidney injury, Major abdominal surgery, Radical cystectomy
Plan
Vol 66
Article 109906- novembre 2020 Retour au numéro
Article précédent
- Predicting postoperative delirium after microvascular decompression surgery with machine learning
- Ying Wang, Lei Lei, Muhuo Ji, Jianhua Tong, Cheng-Mao Zhou, Jian-Jun Yang
- Population pharmacokinetic/pharmacodynamic modeling for remimazolam in the induction and maintenance of general anesthesia in healthy subjects and in surgical subjects
- Jie Zhou, Cathrine Leonowens, Vijay D. Ivaturi, Lauren L. Lohmer, Laura Curd, Joachim Ossig, Frank Schippers, Karl-Uwe Petersen, Thomas Stoehr, Virginia Schmith
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?