The Association Between Perioperative Hemoglobin and Acute Kidney Injury in Patients Having Noncardiac Surgery

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.

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Assessing association between duration of postoperative acute kidney injury and in-hospital mortality after noncardiac surgery

Renal Failure ◽

10.3109/0886022x.2015.1127708 ◽

2015 ◽

Vol 38 (2) ◽

pp. 342-343 ◽

Cited By ~ 2

Author(s):

Yi Liu ◽

Fu-Shan Xue ◽

Gao-Pu Liu ◽

Chao Sun

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Kidney Injury ◽

Noncardiac Surgery

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Near-Infrared Spectroscopy Monitoring in Cardiac and Noncardiac Surgery: Pairwise and Network Meta-Analyses

Journal of Clinical Medicine ◽

10.3390/jcm8122208 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2208 ◽

Cited By ~ 4

Author(s):

Christian Ortega-Loubon ◽

Francisco Herrera-Gómez ◽

Coralina Bernuy-Guevara ◽

Pablo Jorge-Monjas ◽

Carlos Ochoa-Sangrador ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Cardiovascular Events ◽

Near Infrared ◽

Postoperative Mortality ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Meta Analyses

Goal-directed therapy based on brain-oxygen saturation (bSo2) is controversial and hotly debated. While meta-analyses of aggregated data have shown no clinical benefit for brain near-infrared spectroscopy (NIRS)-based interventions after cardiac surgery, no network meta-analyses involving both major cardiac and noncardiac procedures have yet been undertaken. Randomized controlled trials involving NIRS monitoring in both major cardiac and noncardiac surgery were included. Aggregate-level data summary estimates of critical outcomes (postoperative cognitive decline (POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality) were obtained. NIRS was only associated with protection against POCD/POD in cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval (CI)/I2/number of studies (n): 0.34/0.14–0.85/75%/7), although a favorable effect was observed in the analysis, including both cardiac and noncardiac procedures. However, the benefit of the use of NIRS monitoring was undetectable in Bayesian network meta-analysis, although maintaining bSo2 > 80% of the baseline appeared to have the most pronounced impact. Evidence was imprecise regarding acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality. There is evidence that brain NIRS-based algorithms are effective in preventing POCD/POD in cardiac surgery, but not in major noncardiac surgery. However, the specific target bSo2 threshold has yet to be determined.

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