Key result
An intraoperative peripheral perfusion index of less than 0.5 for more than 10% of surgery time was independently associated with a twofold increased risk of postoperative acute kidney injury (OR 2.00).
Why the study?
Few studies have examined the role of intraoperative peripheral perfusion index, which is associated with postoperative morbidity and mortality, in postoperative acute kidney injury.
Is low intraoperative peripheral perfusion index associated with postoperative acute kidney injury in patients undergoing general surgery?
Cohort (n=1,586)
No
Is low intraoperative peripheral perfusion index associated with postoperative acute kidney injury in patients undergoing general surgery?
Low intraoperative peripheral perfusion index (<0.5 for >10% of surgery time) is independently associated with a twofold increased risk of postoperative acute kidney injury.
Low perfusion index associated with postoperative AKI; hypothesis-generating, requiring prospective validation before any practice change.
BACKGROUND: Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI) that has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence. METHODS: We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre- and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB. Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI. RESULTS: Overall, 2,554 patients were identified and 1,586 patients were included in our analysis. According to Kidney Disease Improving Global Outcomes (KDIGO) criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio: 2.00, 95% CI [1.16, 3.44], P = 0.012) when PPI was less than 0.5 for more than 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists physical status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation. CONCLUSIONS: Low intraoperative PPI was independently associated with postoperative AKI.
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Kang et al. (2023) conducted a cohort in Postoperative acute kidney injury (n=1,586). Intraoperative peripheral perfusion index (PPI) < 0.5 for > 10% of surgery time vs. Intraoperative PPI ≥ 0.5 or < 0.5 for ≤ 10% of surgery time was evaluated on Postoperative acute kidney injury (KDIGO criteria) (OR 2.00, 95% CI 1.16, 3.44, p=0.012). An intraoperative peripheral perfusion index of less than 0.5 for more than 10% of surgery time was independently associated with a twofold increased risk of postoperative acute kidney injury (OR 2.00).
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