The Impact of Propofol- and Inhalant-Based Anesthesia on Acute Kidney Injury After Major Abdominal Surgery: A Retrospective Observational Study

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>The optimal anesthetic for preventing postoperative acute kidney injury (AKI) remains unclear, and few studies on this topic have been conducted in the context of non-cardiac surgery. The purpose of this retrospective study was to compare propofol- and inhalant-based anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS).<jats:bold>Methods: </jats:bold>Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from January 2016 to December 2018 were included. Using multivariable logistic regression, the risk of postoperative AKI was compared between patients who underwent propofol-based anesthesia (propofol group) and those who received inhalant-based anesthesia (inhalant group). Additional logistic regression analyses were performed after propensity score matching and inverse probability of treatment weighting (IPTW).<jats:bold>Results:</jats:bold> In total, 3,616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the propofol and inhalant groups, respectively. The risk of AKI was significantly higher in the inhalant group (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.23–2.30;<jats:italic> P</jats:italic>= 0.001) than the propofol group. In the propensity score-matched cohort, the inhalant group had a higher risk of AKI than the propofol group (aOR, 1.68; 95% CI, 1.21–2.34; <jats:italic>P</jats:italic>= 0.002), and the logistic regression with IPTW showed similar results (OR, 1.74; 95% CI 1.14–1.66;<jats:italic> P</jats:italic>&lt; 0.001).<jats:bold>Conclusion:</jats:bold> The risk of AKI after open MAS may differ significantly according to the anesthetic used. Patients receiving inhalant-based anesthesia may have a greater risk of postoperative AKI than those anaesthetized with propofol.</jats:p>