Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis

Essber, Hani; Cohen, Barak; Artis, Amanda; Leung, Steve; Maheshwari, Kamal; Khan, Mohammad Zafeer; Sessler, Daniel I.; Turan, Alparslan; Ruetzler, Kurt

doi:10.1016/j.bjane.2020.12.008

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Furthermore, it remains unclear whether this changing risk for AKI is due to hemodynamic changes or it depends on the amount, duration, and timing of the RFT. Some studies have reported that despite the potential mechanisms of the Trendelenburg position and pneumoperitoneum, laparoscopic surgeries do not increase the risk of AKI without RFT [16]. The present study results highlight the importance of the effect of RFT duration in RALP on the risk of AKI.…”

Section: Discussionsupporting

confidence: 58%

“…However, it is also known that laparoscopic surgical approaches reduce surgical stress and enhance recovery after surgery by reducing neuroendocrine and inflammatory responses [15]. In a retrospective analysis of 3692 patients, Essber et al reported that, despite the potential mechanisms, the laparoscopic surgical approach with the Trendelenburg position did not reduce the postoperative estimated glomerular filtration rate, and it reduced the incidence of postoperative AKI compared to open surgery without the Trendelenburg position [16].…”

Section: Discussionmentioning

confidence: 99%

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Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy

Aktas Yildirim,

Sarikaya,

Dogan

et al. 2023

JPM

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Background: In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in surgeries that utilize the Trendelenburg position and pneumoperitoneum may increase the risk of postoperative AKI. We aimed to evaluate the effect of RFT duration on postoperative AKI. Methods: Forty-four patients who underwent RALP were included in this prospective observational study. Patients were divided into two groups according to the RFT duration (Group I, RFT duration ≤ 3 h, and Group II, RFT duration >3 h). AKI was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria (KDIGO) using patients’ serum creatinine levels after the first 24 h postoperatively. Hemodynamic parameters were monitored using the pressure recording analytical method. Results: The AKI incidence was significantly higher in Group II than in Group I (45.5% vs. 9.1%; p = 0.016). In both groups, all patients who developed AKI were KDIGO stage 1 and all recovered on the second postoperative day. At the end of the console period, the heart rate and arterial elastance were significantly higher, whereas the stroke volume index was significantly lower in Group II than in Group I (p = 0.041, p = 0.016, and p < 0.001, respectively). Although the amounts of fluid administered before and after the anastomosis were similar between the groups, the total amount of fluid administered was significantly different (p < 0.001). There was a significant negative correlation between RFT duration and the total amount of fluid administered (r2 = 0.43, p < 0.001). RFT duration of >3 h, total fluid administration of ≤3.3 mL/kg/h, and stroke volume index (SVI) at the end of the console period of ≤32 mL/m2 increased the risk of AKI by 12.0 times (1.7–85.2) (p = 0.013). Conclusion: RFT prolongation in RALP may increase the risk of developing AKI.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy

Aktas Yildirim,

Sarikaya,

Dogan

et al. 2023

JPM

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“…Intraoperative fluid balance is one of the modifiable risk factors for acute kidney injury [6]. At the same time an adequate fluid therapy is absolutely essential to prevent prerenal acute kidney damage [7].…”

Section: Introductionmentioning

confidence: 99%

Kidney`s functional state assessment when using different regimens of intraoperative fluid therapy

Morozova

Pavlov

2021

SR:MS

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The aim of the research. To study the kidneys functional state when using different regimens of intraoperative fluid therapy in high cardiac risk patients during abdominal surgery. Materials and methods. 142 patients who underwent abdominal surgical interventions mainly for oncoproctological diseases of the gastrointestinal tract, aged over 50 years old and with a history of stable coronary heart disease were divided into four groups depending on the way of intraoperative fluid therapy, which was performed according to two regimens: restrictive (R) and liberal (L). R1 (n=36) with rate of intraoperative fluid therapy 3–5 ml/ kg/ h, R2 (n=35) patients received 5–8 ml/kg/h during surgery, L1 (n=35) with intraoperative fluid rate of 8–11 ml/kg/h and L2 (n=36) – more than 11 ml/kg/h intraoperatively. The study of the functional state of the kidneys included the determination of such indicators as urea, creatinine, diuresis, the degree of AKI according to KDIGO in two stages of the study – before surgery and 18–24 hours after. Results. The greatest tendency to develop acute kidney injury was observed in R1 subgroup with a restrictive intraoperative fluid therapy regimen, and the smallest in L1 subgroup with a relatively liberal regimen. The R2 and L2 subgroups took an intermediate place in the number of renal complications. A high tendency to develop renal dysfunction in patients of R1 subgroup was associated with circulatory hypokinesia and a moderate decrease of renal perfusion. Conclusions. The study found that restriction of infusion in R1 subgroup contributed to the development of renal dysfunction in almost half of the patients. First of all it was associated with a decrease of GFR in conditions of circulatory hypokinesia, which is larger in R1 subgroup and amounted to about 35 %. The safest regimens of intraoperative fluid therapy in relation to renal function in the perioperative period were relatively liberal (subgroup L1) and relatively restrictive (subgroup R2), which provided the least number of complications in patients

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“…10 Circumstances of surgical techniques are likely contributing to this large variation of AKI risk, among them the option of open versus laparoscopic approaches. There are publications advocating either the laparoscopic 1,[11][12][13] or open 14,15 approach, and articles that show no differences 3,[16][17][18][19][20] in postoperative AKI across groups have also been described. While the impact of volume depletion or "classic" noxious agents such as nonsteroid anti-inflammatory drugs, ACE inhibitors, certain antibiotics, or radiocontrast agent exposure are well understood among nephrologists, lack of understanding of intraoperative hemodynamics and documentation may limit quality of Nephrology consultations.…”

mentioning

confidence: 99%

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

et al. 2022

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An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.

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Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis

Cited by 5 publications

References 26 publications

Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy

Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy

Kidney`s functional state assessment when using different regimens of intraoperative fluid therapy

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

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