Yongzhong Tang1, Chaonan Zhu2, Jiabin Liu3, Anli Wang4, Kaiming Duan1, Bo Li5, Hong Yuan6, Hao Zhang7, Min Yao8, Wen Ouyang9. 1. Center of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China. 2. School of Medicine, Zhejiang University, Hangzhou, China. 3. Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA. 4. Information Department, The Third Xiangya Hospital, Central South University, Changsha, China. 5. Operation Room, The Third Xiangya Hospital, Central South University, Changsha, China. 6. Department of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China. 7. Institute of Microelectronics of Chinese of Science, Beijing, China. 8. Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA. 9. Center of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China, yangwenou@126.com.
Abstract
BACKGROUND/AIMS: Intraoperative hypotension (IOH) may be associated with surgery-related acute kidney injury (AKI). However, the duration of hypotension that triggers AKI is poorly understood. The incidence of AKI with various durations of IOH and mean arterial pressures (MAPs) was investigated. MATERIALS: A retrospective cohort study of 4,952 patients undergoing noncardiac surgery (2011 to 2016) with MAP monitoring and a length of stay of one or more days was performed. The exclusion criteria were a preoperative estimated glomerular filtration (eGFR) ≤60 mL min-1 1.73 m2-1, a preoperative MAP less than 65 mm Hg, dialysis dependence, urologic surgery, age older than 60 years, and a surgical duration of less than 60 min. The primary exposure was IOH, and the primary outcome was AKI (50% or 0.3 mg dL-1 increase in creatinine) during the first 7 postoperative days. Multivariable logistic regression was used to model the exposure-outcome relationship. RESULTS: AKI occurred in 186 (3.76%) noncardiac surgery patients. The adjusted odds ratio for surgery-related AKI for a MAP of less than 55 mm Hg was 14.11 (95% confidence interval: 5.02-39.69) for an exposure of more than 20 min. Age was not an interaction factor between AKI and IOH. CONCLUSION: There was a considerably increased risk of postoperative AKI when intraoperative MAP was less than 55 mm Hg for more than 10 min. Strict blood pressure management is recommended even for patients younger than 60 years old.
BACKGROUND/AIMS: Intraoperative hypotension (IOH) may be associated with surgery-related acute kidney injury (AKI). However, the duration of hypotension that triggers AKI is poorly understood. The incidence of AKI with various durations of IOH and mean arterial pressures (MAPs) was investigated. MATERIALS: A retrospective cohort study of 4,952 patients undergoing noncardiac surgery (2011 to 2016) with MAP monitoring and a length of stay of one or more days was performed. The exclusion criteria were a preoperative estimated glomerular filtration (eGFR) ≤60 mL min-1 1.73 m2-1, a preoperative MAP less than 65 mm Hg, dialysis dependence, urologic surgery, age older than 60 years, and a surgical duration of less than 60 min. The primary exposure was IOH, and the primary outcome was AKI (50% or 0.3 mg dL-1 increase in creatinine) during the first 7 postoperative days. Multivariable logistic regression was used to model the exposure-outcome relationship. RESULTS: AKI occurred in 186 (3.76%) noncardiac surgery patients. The adjusted odds ratio for surgery-related AKI for a MAP of less than 55 mm Hg was 14.11 (95% confidence interval: 5.02-39.69) for an exposure of more than 20 min. Age was not an interaction factor between AKI and IOH. CONCLUSION: There was a considerably increased risk of postoperative AKI when intraoperative MAP was less than 55 mm Hg for more than 10 min. Strict blood pressure management is recommended even for patients younger than 60 years old.
Authors: Anthony Bonavia; Milad Javaherian; Alexander J Skojec; Vernon M Chinchilli; Berend Mets; Kunal Karamchandani Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817
Authors: Anne Gregory; Wolf H Stapelfeldt; Ashish K Khanna; Nathan J Smischney; Isabel J Boero; Qinyu Chen; Mitali Stevens; Andrew D Shaw Journal: Anesth Analg Date: 2021-06-01 Impact factor: 6.627