Association of intra‐operative hypotension with acute kidney injury, myocardial injury and mortality in non‐cardiac surgery: A meta‐analysis

Abstract

Background Intra‐operative hypotension might induce poor postoperative outcomes in non‐cardiac surgery, and the relationship between the level or duration of Intra‐operative hypotension (IOH) and postoperative adverse events is still unclear. In this study, we performed a meta‐analysis to determine how IOH could affect acute kidney injury (AKI), myocardial injury and mortality in non‐cardiac surgery. Methods We searched PubMed (Medline), Embase, Springer, The Cochrane Library, Ovid and Google Scholar, and retrieved the related clinical trials on intra‐operative hypotension and prognosis in non‐cardiac surgery. Results Fifteen observational studies were included. The meta‐analysis showed that in non‐cardiac surgery, intra‐operative hypotension (mean arterial pressure [MAP]) <60 mm Hg for more than 1 minute was associated with an increased risk of postoperative acute kidney injury(AKI) [1‐5 minutes: odds ratio (OR) = 1.13, 95% CI (1.04, 1.23), I2 = 0, P = .003; 5‐10 minutes: OR = 1.18, 95% CI (1.07, 1.31), I2 = 0, P = .001; >10 minutes: OR = 1.35, 95% CI (1.1, 1.67), I2 = 52.6%, P = .004] and myocardial injury [1‐5 minutes: OR = 1.16, 95% CI (1.01, 1.33), I2 = 30.6%, P = .04; 5‐10 minutes: OR = 1.34, 95% CI (1.01, 1.77), I2 = 70.4%, P = .046; >10 minutes: OR = 1.43, 95% CI (1.18, 1.72), I2 = 39.4%, P < .0001]. Intra‐operative hypotension (MAP < 60 mm Hg) for 1‐5 minutes was not associated with postoperative 30‐day mortality [OR = 1.15, 95% CI (0.95, 1.4), I2 = 0, P = .154], but intra‐operative hypotension (MAP < 60 mm Hg) for more than 5 min was associated with an increased risk of postoperative 30‐day mortality [OR = 1.11, 95% CI (1.06, 1.17), I2 = 51.9%, P < .0001]. Conclusion Intra‐operative hypotension was associated with an increased risk of postoperative AKI, myocardial injury and 30‐day mortality in non‐cardiac surgery. Intra‐operative MAP < 60 mm Hg more than 1 minute should be avoided.

Intraoperative Hypotension during Liver Transplant Surgery is Associated with Postoperative Acute Kidney: A Retrospective Cohort Study

“…Multiple large retrospective studies have shown an association between IOH and postoperative AKI, [13][14][15][16][17][18][19][20]22] and others have reported an association between the duration of IOH and cardiac, renal and neurological adverse events. [13,17,23,24] However, this association remains poorly de ned in the context of liver transplantation.…”

“…[7][8][9][10][11][12] Haemodynamic variable such as intraoperative hypotension (IOH), most often de ned as a mean arterial pressure (MAP) ≤ 65 mmHg, has been shown to be one of the most important factors associated with postoperative AKI. [13] Numerous large retrospective studies have shown that IOH is associated with postoperative AKI after various types of non-cardiac surgery, [14][15][16][17][18][19] but data on such an association in liver transplantation remain scarce. [20] We therefore conducted a historical cohort analysis to evaluate the association between IOH and the development of postoperative AKI in patients undergoing liver transplant surgery.…”

Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study

“…They found that IOH was associated with an increased risk of postoperative AKI and myocardial injury. In more detail, the duration of IOH lasting only more than 5 min was associated with an increased risk of 30-day mortality [21]. In particular, patients suffering from pre-existing CVDs may have increased risks of perioperative cardiovascular morbidity and mortality following noncardiac surgery.…”

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

“…Episodes of intraoperative hypotension, defined as mean arterial pressure (MAP) below 60 mmHg, may decrease renal perfusion, resulting in AKI in patients with impaired autoregulation [ 54 , 55 , 56 ]. Sun demonstrated that sustained intraoperative periods of MAP less than 55 mmHg (2.34 (95% CI 1.35–4.05)) and less than 60 mmHg (OR 1.84 (95% CI 1.11 to 3.06)) were associated with postoperative AKI [ 54 ].…”

“…Sun demonstrated that sustained intraoperative periods of MAP less than 55 mmHg (2.34 (95% CI 1.35–4.05)) and less than 60 mmHg (OR 1.84 (95% CI 1.11 to 3.06)) were associated with postoperative AKI [ 54 ]. Also, intraoperative hypotension for more than 1 min is significantly associated with an increased risk of postoperative AKI [ 55 ]. Thus avoidance of intraoperative hypotension could decrease the risk of AKI.…”