Impact of intraoperative hypotension and blood loss on acute kidney injury after pancreas surgery

Ida, Mitsuru; Sumida, Mariko; Naito, Yusuke; Tachiiri, Yuka; Kawaguchi, Masahiko

doi:10.1016/j.bjane.2020.07.001

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Thus, relative IOH thresholds may have a potential to better predict AKI than the rigid, absolute values that were found by studies of larger, more heterogeneous populations. Interestingly, Ida et al found that increased area under MAP <65 mmHg along with blood loss >500 mL contributed to postoperative AKI in pancreatic surgery (AUROC=0.68) [33]; the study included 274 patients (22 AKI cases) undergoing various pancreatic procedures, with a significantly lower procedure duration (median 296 min). Our study, however, provided a slightly improved AUROC (0.70) for a more homogeneous group with greater number of AKI cases.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

et al. 2023

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Background:Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to postoperative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who underwent PD and evaluated IOH as a factor associated with AKI. Material/Methods:We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO criteria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean arterial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regression models with previously established independent variables. Results:We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. Conclusions:In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

et al. 2023

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“…Sensitivity tests were performed on four subgroups: i) eGFR <90 mL/min/1.73 m 2 , ii) intraoperative blood loss <1000 ml, iii) non-diabetes, and iv) older (age ≥60 years). These subgroups were chosen since eGFR ( Shen et al, 2022 ), diabetes mellitus ( Patschan and Müller, 2016 ), intraoperative blood loss ( Ida et al, 2020 ), and advanced age ( Abdel-Kader and Palevsky, 2009 ) were all associated with AKI risk. We selected two AKI high-risk subgroups and two AKI low-risk subgroups for analysis to demonstrate the stability of the relationship between dexmedetomidine and postoperative AKI.…”

Section: Methodsmentioning

confidence: 99%

Correlation between perioperative dexmedetomidine administration and postoperative acute kidney injury in hypertensive patients undergoing non-cardiac surgery

Chen

Zeng

et al. 2023

Front. Pharmacol.

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Background: Previous studies have suggested that dexmedetomidine may have a protective effect on renal function. However, it is currently unclear whether perioperative dexmedetomidine administration is associated with postoperative acute kidney injury (AKI) incidence risk in hypertensive patients undergoing non-cardiac surgery.Methods: This investigation was a retrospective cohort study. Hypertensive patients undergoing non-cardiac surgery in Third Xiangya Hospital of Central South University from June 2018 to December 2019 were included. The relevant data were extracted through electronic cases. The univariable analysis identified demographic, preoperative laboratory, and intraoperative factors associated with acute kidney injury. Multivariable stepwise logistic regression was used to assess the association between perioperative dexmedetomidine administration and postoperative acute kidney injury after adjusting for interference factors. In addition, we further performed sensitivity analyses in four subgroups to further validate the robustness of the results.Results: A total of 5769 patients were included in this study, with a 7.66% incidence of postoperative acute kidney injury. The incidence of postoperative acute kidney injury was lower in the dexmedetomidine-administered group than in the control group (4.12% vs. 8.06%, p < 0.001). In the multivariable stepwise logistic regression analysis, perioperative dexmedetomidine administration significantly reduced the risk of postoperative acute kidney injury after adjusting for interference factors [odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.36–0.87, p = 0.010]. In addition, sensitivity analysis in four subgroups indicated parallel findings: i) eGRF <90 mL/min·1.73/m2 subgroup (OR = 0.40, 95% CI: 0.19–0.84, p = 0.016), ii) intraoperative blood loss <1000 mL subgroup (OR = 0.58, 95% CI: 0.36–0.94, p = 0.025), iii) non-diabetes subgroup (OR = 0.51, 95% CI: 0.29–0.89, p = 0.018), and iv) older subgroup (OR = 0.55, 95% CI: 0.32–0.93, p = 0.027).Conclusion: In conclusion, our study suggests that perioperative dexmedetomidine administration is associated with lower risk and less severity of postoperative acute kidney injury in hypertensive individuals undergoing non-cardiac surgery. Therefore, future large-scale RCT studies are necessary to validate this benefit.

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Robotic Versus Laparoscopic Partial Nephrectomy: A Prospective, Randomised Trial Comparing Two Surgical Techniques

Oberhammer

Lusuardi

Kunit

et al. 2022

Preprint

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Purpose: To compare oncological, peri-, and postoperative outcomes of robot-assisted with those of laparoscopic partial nephrectomy. Patients and Methods: Thirty patients with low- or moderate-complexity renal tumors (R.E.N.A.L. nephrometry scoring) were randomized in a single-blind manner and operated on by the robot-assisted (n = 13) or laparoscopic (n = 17) approach. The primary outcome was oncological safety, based on the residual tumor (R) classification. Secondary outcome parameters were perioperative and postoperative results. The open-source R statistical software was used for statistical analysis. Results: Oncological outcomes did not differ significantly between the two surgical methods (p = 0.58). Operating time (p = 0.105), ischemia time (p = 0.884), overall length of hospital stay (p = 0.664), postoperative pain, and preoperative and in-hospital renal function scores were similar. Creatinine levels differed significantly six months postoperatively (robotic: 0.9 mg/dl versus laparoscopic: 1.1 mg/dl; p= 0.014). Intraoperative blood loss was significantly greater in the laparoscopic group (400 ml versus 168 ml; p = 0.028), which was also reflected in postoperative hemoglobin levels (13.8 mg/dl versus 12.5 mg/dl; p = 0.012). Peri- or postoperative complications did not differ significantly (p = 0.355). Subgroup analysis revealed significantly more frequent complications in patients with moderate-complexity tumors treated by laparoscopic surgery (p = 0.021). Conclusions: The oncological outcome in regard to the R status was similar in both groups. Intraoperative blood loss, postoperative renal function, and complications all benefited from robot-assisted surgery. Trial registration: The study was registered on ClinicalTrials.gov (NCT03900364; 03/04/2019).

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Impact of intraoperative hypotension and blood loss on acute kidney injury after pancreas surgery

Cited by 3 publications

References 17 publications

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

Correlation between perioperative dexmedetomidine administration and postoperative acute kidney injury in hypertensive patients undergoing non-cardiac surgery

Robotic Versus Laparoscopic Partial Nephrectomy: A Prospective, Randomised Trial Comparing Two Surgical Techniques

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