Key result
A perioperative hemoglobin drop greater than 43 g/L was significantly associated with an increased risk of acute kidney injury after noncardiac surgery (OR 3.29 after propensity score weighting).
Why the study?
Consensus is lacking on the tolerable difference in postoperative hemoglobin drop for patients with different preoperative hemoglobin levels.
Does the threshold of perioperative hemoglobin drop for postoperative AKI differ based on preoperative anemia status in patients undergoing noncardiac surgery?
Cohort (n=35,631)
No
Does the threshold of perioperative hemoglobin drop for postoperative AKI differ based on preoperative anemia status in patients undergoing noncardiac surgery?
Answers are grounded in this paper and cite their sources.
Patients with preoperative anemia have a lower tolerance for perioperative hemoglobin drop (threshold 18 g/L) before developing acute kidney injury compared to those without anemia (threshold 43 g/L).
BACKGROUND: Perioperative hemoglobin drop after noncardiac surgery is associated with acute kidney injury (AKI). However, opinion on the tolerable difference in postoperative hemoglobin drop in patients with different preoperative hemoglobin levels does not reach a consensus. This study aimed to identify hemoglobin drop thresholds for AKI after noncardiac surgery stratified by preoperative hemoglobin levels. METHOD: This was a single-center retrospective cohort study for elective noncardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The generalized additive model described the non-linear relationship between hemoglobin drop and AKI occurrence. The minimum P-value approach identified cut-off points of hemoglobin drop within postoperative 7 days for patients with or without preoperative anemia. Stratified by preoperative anemia, hemoglobin drop's odds ratio as continuous, quintile and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting (PSW). RESULTS: Of the 35,631 surgery, 5.9% (2105 cases) suffered postoperative AKI. Non-linearity was found between hemoglobin drop and postoperative AKI occurrence. The thresholds and corresponding odds ratio of perioperative hemoglobin drop for patients with and without preoperative anemia were 18 g/L (1.38 (95%CI 1.14 -1.62), P < .001; after PSW: 1.42 (95%CI 1.17 -1.74), P < .001) and 43 g/L (1.81 (95%CI 1.35-2.27), P < .001; after PSW: 2.88 (95%CI 1.85-4.50), P < .001) respectively. Overall thresholds and corresponding odds ratio were 43 g/L (1.82 (95%CI 1.42-2.21)), P < .001; after PSW: 3.29 (95%CI 2.00-5.40), P < .001). Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that intraoperatively female patients undergoing intraperitoneal surgery without colloid infusion seemed to be more vulnerable to higher hemoglobin drop. Further analysis showed a possible linear relationship between preoperative hemoglobin and perioperative hemoglobin drop thresholds. Additionally, this study found that the creatinine level changed simultaneously with hemoglobin level within five postoperative days. CONCLUSIONS: Heterogeneity of hemoglobin drop endurability exists after noncardiac non-kidney surgery. More care and earlier intervention should be put on patients with preoperative anemia.
No takes yet. Share an insight, caveat, or question.
Zhou et al. (2022) conducted a cohort in Acute kidney injury after noncardiac surgery (n=35,631). Perioperative hemoglobin drop > 43 g/L vs. Perioperative hemoglobin drop ≤ 43 g/L was evaluated on Occurrence of acute kidney injury (AKI) 7 days postoperatively (OR 3.29, 95% CI 2.00-5.40, p=<0.001). A perioperative hemoglobin drop greater than 43 g/L was significantly associated with an increased risk of acute kidney injury after noncardiac surgery (OR 3.29 after propensity score weighting).
Synapse has enriched 10 related papers. Consider them for comparative context: