Intraoperative hypotension and postoperative acute kidney injury or myocardial injury after liver resection: A protocol for a systematic review and meta-analysis

Background Liver resection creates a clinical tension between limiting operative bleeding and maintaining organ perfusion. Low central venous pressure, fluid restriction, vascular inflow occlusion and vasoactive treatment can coincide with lower arterial pressure, yet existing reviews have centred on blood loss and transfusion. They have not resolved whether directly quantified intraoperative hypotension is associated with postoperative acute kidney injury or myocardial injury, or whether comparative haemodynamic strategies alter these outcomes. We will address both questions while keeping exposure associations distinct from management effects and kidney outcomes distinct from myocardial outcomes. Methods This prospectively registered review will search four bibliographic databases and two trial registries from inception, supplemented by citation searching and author contact, without language or date restrictions. Eligible studies will include adults undergoing partial liver resection and report a quantified intraoperative arterial-hypotension exposure or a comparative pressure- or flow-directed strategy with acute kidney injury or myocardial injury. Two reviewers will independently select studies, extract data and assess risk of bias, with independent handling of review-team-authored studies. Four prespecified synthesis domains will separate exposure from management evidence and kidney from myocardial outcomes. Compatible estimates will undergo random-effects meta-analysis; otherwise, structured synthesis without meta-analysis will be used. Heterogeneity, missing evidence and certainty will be assessed. This design aims to distinguish prognostic association from evidence about modifiable haemodynamic management. Registration PROSPERO CRD420261476933 ; Open Science Framework https://doi.org/10.17605/OSF.IO/3GCY2 .