Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Rossouw, E; Chetty, Sean

doi:10.7196/samj.2023.v113i3.16783

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…The eligible participants included older adult patients who underwent major non-cardiac surgeries. Major non-cardiac surgery referred to the surgical procedure associated with significant fluid shifts that required postoperative hospitalization, 12 which included open resection of organs, thoracic surgery, intracranial surgery, spinal surgery, large joint replacement, laparoscopic surgery. The inclusion criteria included: patients age ≥65 years, surgical duration ≥2 hours, and elective surgery under general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study

Yang,

Feng,

Wang

et al. 2024

CIA

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Background Noradrenaline (NA) is commonly used intraoperatively to prevent fluid overload and maintain hemodynamic stability. Clinical studies provided inconsistent results concerning the effect of NA on postoperative outcomes. As aging is accompanied with various diseases and has the high possibility of the risk for postoperative complications, we hypothesized that intraoperative NA infusion in older adult patients undergoing major non-cardiac surgeries might potentially exert adverse outcomes. Methods In this retrospective propensity score-matched cohort study, older adult patients undergoing major non-cardiac surgeries were selected, 1837 receiving NA infusion during surgery, and 1072 not receiving NA. The propensity score matching was conducted with a 1:1 ratio and 1072 patients were included in each group. The primary outcomes were postoperative in-hospital mortality and complications. Results Intraoperative NA administration reduced postoperative urinary tract infection (OR:0.124, 95% CI:0.016–0.995), and had no effect on other postoperative complications and mortality, it reduced intraoperative crystalloid infusion (OR:0.999, 95% CI:0.999–0.999), blood loss (OR: 0.998, 95% CI: 0.998–0.999), transfusion (OR:0.327, 95% CI: 0.218–0.490), but increased intraoperative lactate production (OR:1.354, 95% CI:1.051–1.744), and hospital stay (OR:1.019, 95% CI:1.008–1.029). Conclusion Intraoperative noradrenaline administration reduces postoperative urinary tract infection, and does not increase other postoperative complications and mortality, and can be safely used in older adult patients undergoing major non-cardiac surgeries.

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Section: Methodsmentioning

confidence: 99%

Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study

Yang,

Feng,

Wang

et al. 2024

CIA

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“…The eligible participants included elderly patients who underwent major oncologic surgeries. Major oncologic surgery referred to the surgical procedure associated with signi cant uid shifts that required postoperative hospitalization [13], which included open resection of organs, thoracic surgery, intracranial surgery, laparoscopic surgery and orthopedic cancer surgery. The inclusion criteria included: patients age ≥ 65 years, surgical duration ≥ 2 hours, and elective oncologic surgery under general anesthesia.…”

Section: Participantsmentioning

confidence: 99%

Association between intraoperative noradrenaline infusion and outcomes in elderly patients undergoing major oncologic surgeries: A retrospective propensity score-matched cohort study

Yang,

Feng,

Wang

et al. 2023

Preprint

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Background:Noradrenaline (NA) is commonly used intraoperatively to prevent fluid overload and maintain hemodynamic stability. Animal and clinical studies provided inconsistent results concerning the effect of NA on postoperative outcomes. As aging is accompanied with various diseases and has the high possibility of the risk for postoperative complications, we hypothesized that intraoperative NA infusion in elderly patients undergoing major oncologic surgeries might potentially exert adverse outcomes. Methods: In this retrospective propensity score-matched cohort study, elderly patients undergoing major oncologic surgeries were selected, 1837 receiving NA infusion during surgery, and 1072 not receiving NA. The propensity score matching was conducted with a 1:1 ratio and 1072 patients were included in each group. The primary outcomes were postoperative in-hospital mortality and complications. Results:Intraoperative NA administration reduced postoperative urinary tract infection (OR:0.124, 95% CI: 0.016-0.995), and had no effect on other postoperative complications and mortality, it reduced intraoperative crystalloid infusion (OR:0.999, 95% CI: 0.999-0.999), blood loss (OR: 0.998, 95% CI: 0.998-0.999), transfusion (OR:0.327, 95% CI: 0.218-0.490), but increased intraoperative lactate production (OR:1.354, 95% CI: 1.051-1.744), and hospital stay (OR:1.019, 95% CI: 1.008-1.029). Conclusions: Noradrenaline has little impact on postoperative complications and mortality in elderly patients undergoing major oncologic surgeries, and can be safely administered intraoperatively.

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The effect of dexmedetomidine on acute kidney injury after elective major abdominal surgery : a retrospective single-center propensity score matched study

Liu,

Luo,

Qian

et al. 2024

BMC Anesthesiol

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Background Major abdominal surgery is a kind of high-risk surgery type for postoperative acute kidney injury (AKI) among non-cardiac surgeries. Despite dexmedetomidine exerts significant renal protective effects in cardiac surgeries and animal studies, whether it is associated with a lower incidence of AKI in major abdominal surgeries remains unclear. Methods From January 2019 to July 2021, patients undergoing elective major abdominal surgery in West China Hospital were enrolled. Participants were divided into two groups based on exposure to continuous intravenous dexmedetomidine: the Dex group (exposed) and the Control group (not exposed). The primary outcome was the incidence of AKI in the postoperative 7 days. Secondary outcomes included intraopertive average urine output, renal function on the first day after surgery, incidence of postoperative dialysis, postoperative intensive care unit (ICU) admission, in-hospital mortality, length of hospital stay, incidence of intraoperative hypotension and bradycardia, and intraoperative use of inotropes and vasopressors. Propensity score matching (PSM), based on participants’ baseline and intraoperative characteristics, was performed to minimize potential bias. Furthermore, a subgroup analysis was conducted based on the infusion rate and the use of a loading dose to explore the effects of different methods of dexmedetomidine administration on AKI. The subgroups included: loading dose, non-loading dose, low-infusion rate (infusion rate ≤ 0.4 µg/kg/h), and high-infusion rate (infusion rate > 0.4 µg/kg/h). Results After PSM with a ratio of 1:1, a total of 8836 patients were successfully matched. Dexmedetomidine administration had no association with the incidence of postoperative AKI, serum creatinine (Scr) level on the first postoperative day, incidence of postoperative dialysis, postoperative ICU admission, in-hospital mortality, length of hospital stay, intraoperative hypotension, or the use of inotropes and vasopressors, but had association with increased intraoperative average urine output (122.95 (76.80, 189.27) vs. 104.65 (67.04, 161.07) ml/h, P < 0.001), higher value of estimated glomerular filtration rate (eGFR) (97.33 ± 15.95 vs. 96.13 ± 16.35 ml/min/1.73m 2 , P < 0.001) on the first day after surgery and a higher incidence of intraoperative bradycardia (37.0% vs. 30.6%; P < 0.001). In the loading dose subgroup, dexmedetomidine use was significantly associated with a reduced incidence of postoperative AKI (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.23–0.76, P = 0.006).The association between dexmedetomidine and postoperative AKI was absent in subgroups of high or low infusion rate and no loading dose use. Conclusion In this single-center retrospective propensity-matched study, we did not detect a significant overall...

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Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Cited by 4 publications

References 34 publications

Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study

Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study

Association between intraoperative noradrenaline infusion and outcomes in elderly patients undergoing major oncologic surgeries: A retrospective propensity score-matched cohort study

The effect of dexmedetomidine on acute kidney injury after elective major abdominal surgery : a retrospective single-center propensity score matched study

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