Key result
Sevoflurane anesthesia was associated with a higher incidence of postoperative acute kidney injury compared to propofol after colorectal surgery (11.2% vs 8.9%; OR 1.29, P=0.03 by AKIN criteria).
Why the study?
Does sevoflurane increase postoperative acute kidney injury compared to propofol in patients undergoing colorectal surgery?
Cohort (n=4,320)
Does sevoflurane increase postoperative acute kidney injury compared to propofol in patients undergoing colorectal surgery?
Odds Ratio: 1.29
Absolute Event Rate: 11.2% vs 8.9%
p-value: p=0.03
Sevoflurane anesthesia may be associated with a modest increase in the incidence of postoperative acute kidney injury compared to propofol in patients undergoing colorectal surgery, though the clinical significance remains uncertain.
Propofol may modestly lower postoperative AKI risk versus sevoflurane after colorectal surgery; observational data leave causal effect and practice change open.
BACKGROUND: Acute kidney injury (AKI) is a primary cause of morbidity and mortality after major abdominal surgery; however, little is known about the effect of anesthetics on the development of AKI after colorectal surgery. The objective of this study was to compare the effects of anesthesia with propofol and sevoflurane on postoperative AKI after colorectal surgery. METHODS: For this study, we reviewed the electronic medical records of 4320 patients who underwent colorectal surgeries between January 2008 and December 2011. The influence of propofol and sevoflurane on the development of postoperative AKI and short-term outcomes was assessed by multivariable analysis, and the effect of the anesthetic agent on overall mortality was analyzed by a Cox proportional hazard model with propensity score matching method. RESULTS: Overall, the incidence of AKI was 9.6% by Acute Kidney Injury Network (AKIN) criteria and 5.8% by risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria. The incidence of AKI incidence was greater in patients receiving sevoflurane than those receiving propofol (142 [11.2%] vs 272 [8.9%], P = 0.02 by AKIN criteria, 94 [7.4%] vs 157 [5.1%], P = 0.004 by RIFLE criteria). Multivariate logistic regression and propensity score matching results indicated that, when compared with propofol, sevoflurane anesthesia may be associated with the development of postoperative AKI (odds ratio [OR], 1.29; P = 0.03; and OR, 1.44; P = 0.02 by AKIN and RIFLE criteria, and OR, 1.41; P = 0.04 by RIFLE criteria, respectively). We found no relationship between sevoflurane and overall mortality. CONCLUSIONS: Compared with anesthesia with propofol, anesthesia with sevoflurane may be associated with a modest increase in the incidence of AKI when RIFLE but not AKIN criteria are used. Thus, the clinical meaning of these results is uncertain. Further work is needed to clarify the relevance of such an association.
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Bang et al. (2016) conducted a cohort in colorectal surgery (n=4,320). Sevoflurane vs. Propofol was evaluated on Postoperative acute kidney injury (AKIN criteria) (OR 1.29, p=0.03). Sevoflurane anesthesia was associated with a higher incidence of postoperative acute kidney injury compared to propofol after colorectal surgery (11.2% vs 8.9%; OR 1.29, P=0.03 by AKIN criteria).
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