Key result
Intraoperative mean arterial pressure ≤60 mm Hg is linked to ~23% higher AKI risk after major abdominal surgery.
Why the study?
It was unclear whether intraoperative hypotension affects postoperative acute kidney injury depending on the invasiveness of abdominal surgery.
Does exposure to intraoperative hypotension increase the risk of postoperative acute kidney injury depending on the invasiveness of abdominal surgery?
Cohort (n=448)
No
Does exposure to intraoperative hypotension increase the risk of postoperative acute kidney injury depending on the invasiveness of abdominal surgery?
Odds Ratio: 1.23 (95% CI 1–1.52)
p-value: p=0.049
Maintaining intraoperative MAP >60 mmHg is critical to preventing acute kidney injury during highly invasive abdominal surgeries, whereas lower thresholds appear to pose less risk during minimally invasive procedures.
MAP ≤60 mm Hg was associated with higher AKI risk in highly invasive surgery; leaves open whether MAP targets warrant adjustment in prospective trials.
Intraoperative hypotension (IOH) or highly invasive surgery adversely affects postoperative clinical outcomes. It is, however, unclear whether IOH affects postoperative acute kidney injury (AKI) depending on the invasiveness of abdominal surgery. We speculated that IOH in highly invasive abdominal surgery is a significant risk factor for postoperative AKI. We retrospectively reviewed the data of 448 patients who underwent abdominal surgery. Patients were divided into 3 groups: highly (such as pancreaticoduodenectomy and hepatectomy), moderately (open abdominal surgery), and minimally (laparoscopic surgery) invasive surgeries. The association between the time-weighted average (TWA) of mean arterial pressure (MAP) values (≤60 and ≤ 55 mm Hg) and AKI occurrences in each group was assessed. Postoperative AKI occurred after highly, moderately, and minimally invasive surgeries in 33 of 222 (14.9%), 14 of 110 (12.7%), and 12 of 116 (10.3%) cases, respectively (P = .526). The median [interquartile range] of TWA-MAP ≤ 60 mm Hg, as an IOH parameter, was 0.94 [0.33-2.08] mm Hg in highly, 0.54 [0.16-1.46] mm Hg in moderately, and 0.14 [0.03-0.57] mm Hg in minimally invasive surgeries (P < 0001). In addition, there was a significant association between TWA-MAP and AKI in highly invasive surgery, unlike in moderately and minimally invasive surgery, with adjusted odds ratios (95% confidence interval) for TWA-MAP ≤ 60 and ≤ 55 mm Hg associated with AKI of 1.23 [1.00-1.52] (P = .049) and 1.55 [1.02-2.36] (P = .041), respectively. Intraoperative MAP ≤ 60 mm Hg in highly invasive abdominal surgery is associated with postoperative AKI, compared to moderately and minimally invasive surgeries. Additionally, low MAP thresholds in highly invasive surgery increase postoperative AKI risk.
No takes yet. Share an insight, caveat, or question.
Fujii et al. (2023) conducted a cohort in Patients undergoing abdominal surgery (n=448). Intraoperative hypotension (Time-weighted average MAP ≤ 60 mm Hg) vs. No intraoperative hypotension or higher MAP thresholds was evaluated on Association between TWA-MAP ≤ 60 mm Hg and postoperative acute kidney injury in highly invasive surgery (OR 1.23, 95% CI 1.00-1.52, p=0.049). Exposure to an intraoperative time-weighted average mean arterial pressure ≤ 60 mm Hg significantly increased the risk of postoperative acute kidney injury by 23% in patients undergoing highly invasive abdominal surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: