Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

Putowski, Zbigniew; Majewska, Karolina; Gruca, Karol; Zimnoch, Aleksandra; Szczepańska, Anna; Krzych, Łukasz J.; Jabłońska, Beata; Mrowiec, Sławomir

doi:10.12659/msm.938945

Cited by 6 publications

(7 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… The overall incidence of AKI in our study cohort, assessed through KDIGO criteria (10%), aligns with previous research on major intraabdominal and pancreatic surgery [ 1 , 11 , 14 , 29 , 30 ]. Our investigation reveals no significant uni- or multivariate association between intraoperative fluid management, MAP < 55 mmHg (cumulative duration > 10 min), or vasopressor administration and postoperative AKI or clinically relevant POPF.…”

Section: Discussionsupporting

confidence: 86%

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

J Anesth Analg Crit Care

View full text Add to dashboard Cite

Background Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery. Methods This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018–December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes. Results AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI Risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI Risk score (OR = 6.3, 95% C.I. 2.4–16.4) were associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality. Conclusion In this analysis, intraoperative volume administration, vasopressor therapy, and a blood pressure < 55 mmHg for more than 10 min were not associated with an increased risk of AKI. After multivariate analysis, male gender and an elevated AKI Risk score were associated with an increased likelihood of AKI.

show abstract

Section: Discussionsupporting

confidence: 86%

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

J Anesth Analg Crit Care

View full text Add to dashboard Cite

show abstract

“…In one study of 303 patients undergoing pancreaticoduodenectomy, a MAP <55 mmHg (n=38, 12.5%) was associated with AKI (OR 2.3, 95% CI 1.02-4.87) in a multivariate analysis. [14] In contrast, our incidence of (8.5%) of an intraoperative MAP <55 mmHg was not associated with AKI in uni-(p=0.4) or multivariate modeling (p=0.6), challenging the assertion that intraoperative hypotension is a risk factor for AKI development in pancreatic surgery.…”

Section: Discussionmentioning

confidence: 56%

“…The overall incidence of AKI in our study cohort, assessed through KDIGO criteria (10%), aligns with previous research on major intraabdominal and pancreatic surgery. [1,11,14,30,31] 2. Our investigation reveals no signi cant uni-or multivariate association between intraoperative uid management, MAP < 55mmHg (cumulative duration > 10 minutes), or vasopressor administration and postoperative AKI or clinically relevant POPF.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Intraoperative improvements in uid and blood pressure management may further reduce the overall rate of postoperative complications, including pancreatic stula and Clavien-Dindo complications. [9][10][11][12][13][14][15] Implementing enhanced recovery pathways for pancreatic surgery incorporates many evidence-based activities that have improved clinical outcomes and reduced costs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

Preprint

View full text Add to dashboard Cite

BACKGROUND Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery.METHODS This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018- December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes.RESULTS AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI risk score (OR = 6.3, 95% C.I. 24-16.4) were highly associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality.CONCLUSION Factors such as gender and an AKI RISK score were associated with an increased likelihood of AKI. The development of AKI or a CR-POPF was associated with longer length of stay, discharge to a skilled nursing facility, or death. However, no modifiable volume, vasopressor, or blood pressure targets were identified to decrease the risk of AKI or CR-POPF.

show abstract

“…Hypotension-related organ hypoperfusion is known to increase perioperative morbidity and mortality as well as healthcare utilization. Several studies have linked the occurrence of intraoperative hypotension to postoperative nausea/vomiting, myocardial infarction, postoperative delirium, stroke, acute kidney injury, prolonged postoperative hospital stay, and even fatality [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Since the probability of organ damage and other serious complications is known to increase with the duration of hypotension [ 6 ], blood pressure monitoring for the prevention of perioperative hypotension is critical for avoiding associated complications.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis

et al. 2023

View full text Add to dashboard Cite

Despite the acceptance of carotid ultrasound for predicting patients’ fluid responsiveness in critical care and anesthesia, its efficacy for predicting hypotension and fluid responsiveness remains unclear in the perioperative setting. Electronic databases were searched from inception to May 2023 to identify observational studies focusing on the use of corrected blood flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) for assessing the risks of hypotension and fluid responsiveness. Using FTc as a predictive tool (four studies), the analysis yielded a pooled sensitivity of 0.82 (95% confidence interval (CI): 0.72 to 0.89) and specificity of 0.94 (95% CI: 0.88 to 0.97) for the risk of hypotension (area under curve (AUC): 0.95). For fluid responsiveness, the sensitivity and specificity of FTc were 0.79 (95% CI: 0.72 to 0.84) and 0.81 (95% CI: 0.75 to 0.86), respectively (AUC: 0.87). In contrast, the use of ΔVpeak to predict the risk of fluid responsiveness showed a pooled sensitivity of 0.76 (95% CI: 0.63 to 0.85) and specificity of 0.74 (95% CI: 0.66 to 0.8) (AUC: 0.79). The current meta-analysis provides robust evidence supporting the high diagnostic accuracy of FTc in predicting perioperative hypotension and fluid responsiveness, which requires further studies for verification.

show abstract

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

Cited by 6 publications

References 38 publications

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis

Contact Info

Product

Resources

About