Effect of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Total Knee Arthroplasty

Kim, Ha-Jung; Park, Hee Sun; Go, Yon-Ji; Koh, Won Uk; Kim, Hyungtae; Song, Jun-Gol; Ro, Young Jin

doi:10.3390/jcm8060778

Cited by 15 publications

(14 citation statements)

References 49 publications

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“…Our study has some limitations. First, there were inevitable flaws due to the nature of the retrospective observational design ( 51 ). Second, there were a relatively limited number of patients enrolled in this study.…”

Section: Discussionmentioning

confidence: 99%

Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

et al. 2022

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BackgroundTo build a predictive scoring model based on simple immune and inflammatory parameters to predict postoperative survival in patients with breast cancer.MethodsWe used a brand-new immuno-inflammatory index—pan-immune-inflammation value (PIV)—to retrospectively evaluate the relationship between PIV and overall survival (OS), and based on the results of Cox regression analysis, we established a simple scoring prediction model based on several independent prognostic parameters. The predictive accuracy of the model was evaluated and independently validated.ResultsA total of 1,312 patients were included for analysis. PIV was calculated as follows: neutrophil count (109/L) × platelet count (109/L) × monocyte count (109/L)/lymphocyte count (109/L). According to the best cutoff value of PIV, we divided the patients into two different subgroups, high PIV (PIV > 310.2) and low PIV (PIV ≤ 310.2), associated with significantly different survival outcomes (3-year OS, 80.26% vs. 86.29%, respectively; 5-year OS, 62.5% vs. 71.55%, respectively). Six independent prognostic factors were identified and used to build the scoring system, which performed well with a concordance index (C-index) of 0.759 (95% CI: 0.715–0.802); the calibration plot showed good calibration.ConclusionsWe have established and verified a simple scoring system for predicting prognosis, which can predict the survival of patients with operable breast cancer. This system can help clinicians implement targeted and individualized treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

et al. 2022

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“…Both spinal anaesthesia and general anaesthesia are safe and effective in TKA patients. Previous studies reported that spinal anaesthesia reduces the risk of acute kidney injury, vascular and pulmonary complications, postoperative pain, and opioid-related adverse effects [17,18]. These results were partially explained by varying influences of anaesthetic techniques on the biological stress response to surgery [19].…”

Section: Discussionmentioning

confidence: 99%

Comparison of General and Spinal Anaesthesia on Systemic Inflammatory Response in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis

Kim

Roychoudhury

Lohia³

et al. 2021

Medicina

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Background and Objectives: Some of the postoperative complications following orthopaedic surgeries are associated with a systemic inflammatory response (SIR), which varies depending on the anaesthetic technique. We aimed to compare the effects of general and spinal anaesthesia on the SIR after total knee arthroplasty (TKA), based on C-reactive protein (CRP) levels, the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR). Materials and Methods: Patients who underwent TKA between January 2014 and December 2018 were included. Electronic medical records of the patients were retrospectively reviewed and analysed. To reduce the impact of potential confounding factors, we performed propensity score matching according to the anaesthetic technique. Results: A total of 1311 TKA cases were analysed. After propensity score matching, the maximal CRP value and changes in CRP levels in the general anaesthesia group were higher than those in the spinal anaesthesia group. However, the maximal NLR and PLR and the changes in NLR and PLR were not different between the two groups. There were no differences in postoperative clinical outcomes. Conclusion: Spinal anaesthesia tended to induce a lower inflammatory response than general anaesthesia when considering CRP levels in patients undergoing TKA. However, the effects of anaesthetic techniques on the overall outcomes were not significant.

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“…Some scholars have put forward the hypothesis that compared with general anesthesia, spinal anesthesia can entirely block the sympathetic nerves at the surgical site, reduce the tension of the renin-angiotensin system, increase renal blood ow and urine output. 16,17 The PNB technique can also soothe the sympathetic tension by blocking the peripheral nerve afferent while maintaining the blood vessels' self-regulating capabilities, preserving the stability of the circulatory system, and maintaining perfusion of the vital organs.…”

Section: Discussionmentioning

confidence: 99%

“…They found that patients that received spinal anesthesia had a reduced incidence rate of AKI; however, the difference was not statistically signi cant. 17 In their meta-analysis, Joanne Guay et al found that compared with general anesthesia, there was a reduction in postoperative mortality when spinal anesthesia was used. 18 However, the difference in patients' mortality rate after the use of general anesthesia and general anesthesia plus spinal anesthesia was not statistically signi cant.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have focused on the comparison between general anesthesia and intrathecal anesthesia. [15][16][17][18][19][20] They hypothesized that perioperative hemodynamic instability and nephrotoxic agents are considered the major causes of postoperative AKI. [2][3][4][5][6][7][8][15][16][17][18][19][20] According to this theory, an epidural, which could dramatically reduce the use of potentially nephrotoxic drugs while providing relatively stable hemodynamics, should be far superior to the use of general anesthesia alone.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Effects of Different Regional Blockade Techniques on Occurrence of Acute Kidney Injury (AKI) After Major Thoracic and Abdominal Surgeries Under General Anesthesia: A Propensity Matching Analysis

Zhang¹,

Zhou²,

Liu³

2021

Preprint

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Background: Recently, it has been under consideration that the anesthetic techniques used during general anesthesia may have influence over the development of acute kidney injury and other postoperative outcomes. For this reason, we aimed to compare the effects of different regional blockade techniques (peripheral nerve blockade versus neuraxial epidural) on occurrence of acute kidney injury (AKI) after thoracic and abdominal surgeries under general anesthesia.Methods: In a single-center retrospective cohort study, 2846 patients undergoing elective thoracic or abdominal surgery during a period of seven years were included into the study. The primary endpoint was the occurrence of AKI postoperatively within a seven-day period in-hospital. Perioperative data were obtained and analyzed to provide data for secondary endpoints that include all other outcome related parameters. To reduce the influence of potential confounding factors, propensity score (PS) analysis was performed. Multivariate logistic regression models examined the selection of an epidural or PNB in general anesthesia before and after propensity score weighting analysis.Results: Of the 2846 patients, 7.3% (207 cases) suffered AKI. The odds ratio of AKI for PNB (epidural as reference) was 0.61 (0.40~0.83), P = 0.006. After propensity score matching, the odds ratio for PNB was [0.49 (0.28~0.70), P = 0.001]. All other outcome related parameters were considered and evaluated.Conclusions: After PS matching analysis, there is no difference in secondary outcome analysis of groups that received PNB or epidural neuraxial blockade who were both under general anesthesia. However, patients who received PNB under general anesthesia showed lower incidence of AKI within seven days postoperatively.

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Effect of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Total Knee Arthroplasty

Cited by 15 publications

References 49 publications

Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

Comparison of General and Spinal Anaesthesia on Systemic Inflammatory Response in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis

Comparison of the Effects of Different Regional Blockade Techniques on Occurrence of Acute Kidney Injury (AKI) After Major Thoracic and Abdominal Surgeries Under General Anesthesia: A Propensity Matching Analysis

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