1
|
Yoon HJ, Kim TH, Ko DE, Song JW, Min N, Ham SY. Postoperative Hypoalbuminemia as a Predictor of Acute Kidney Injury After Open Repair of Ruptured Abdominal Aortic Aneurysm. World J Surg 2023; 47:3382-3393. [PMID: 37730902 DOI: 10.1007/s00268-023-07178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Perioperative hypoalbuminemia has a prognostic effect on mortality and morbidity in various cohorts. Patients undergoing open repair of ruptured abdominal aortic aneurysms (rAAA) are at a high risk of hypoalbuminemia due to bleeding and underlying diseases. Hence, this study aimed to investigate the predictive value of immediate postoperative hypoalbuminemia for the risk for acute kidney injury (AKI) in patients undergoing open rAAA repair. METHODS We retrospectively reviewed 143 patients who underwent open rAAA repair between January 2008 and May 2022. The patients were divided into two groups according to the presence of postoperative AKI. The perioperative serum albumin levels of the two groups were compared. The patients were further divided into two groups based on the median immediate postoperative albumin level (2.4 g/dL). The incidence of AKI was compared between the two groups. Multivariate logistic regression analysis was performed to assess the predictors of postoperative AKI. Kaplan-Meier survival curves were used to evaluate potential of AKI and albumin level as prognostic factors for mortality. RESULTS Immediate postoperative serum albumin was significantly lower in the AKI group than in the non-AKI group (2.11 ± 0.62 g/dL vs. 2.59 ± 0.62 g/dL, p < 0.001). The incidence of postoperative AKI was significantly higher in patients with albumin ≤ 2.4 g/dL than in patients with albumin > 2.4 g/dL (53.8% vs. 27.7%, p = 0.002). Immediate postoperative albumin level was an independent predictor of AKI (Odds ratio [OR], 0.310; 95% confidence interval [CI] 0.165-0.583, p < 0.001) and 1-year mortality (OR, 0.230; 95% CI 0.098-0.542, p = 0.001). CONCLUSIONS Immediate postoperative hypoalbuminemia was associated with postoperative AKI and mortality in patients with rAAA.
Collapse
Affiliation(s)
- Hei Jin Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Da Eun Ko
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Narhyun Min
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Yeon Ham
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
- Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, South Korea.
| |
Collapse
|
2
|
Cai J, Tang M, Wu H, Yuan J, Liang H, Wu X, Xing S, Yang X, Duan XD. Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis. Heliyon 2023; 9:e15997. [PMID: 37223701 PMCID: PMC10200862 DOI: 10.1016/j.heliyon.2023.e15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Background Intraoperative hypotension (IOH) is a common side effect of non-cardiac surgery that might induce poor postoperative outcomes. The relationship between the IOH and severe postoperative complications is still unclear. Thus, we summarized the existing literature to evaluate whether IOH contributes to developing severe postoperative complications during non-cardiac surgery. Methods We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and the CBM from inception to 15 September 2022. The primary outcomes were 30-day mortality, acute kidney injury (AKI), major adverse cardiac events (myocardial injury or myocardial infarction), postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Secondary outcomes included surgical-site infection (SSI), stroke, and 1-year mortality. Results 72 studies (3 randomized; 69 non-randomized) were included in this study. Low-quality evidence showed IOH resulted in an increased risk of 30-day mortality (OR, 1.85; 95% CI, 1.30-2.64; P < .001), AKI (OR, 2.69; 95% CI, 2.15-3.37; P < .001), and stroke (OR, 1.33; 95% CI, 1.21-1.46; P < .001) after non-cardiac surgery than non-IOH. Very low-quality evidence showed IOH was associated with a higher risk of myocardial injury (OR, 2.00; 95% CI, 1.17-3.43; P = .01), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.16; P < .001), and POD (OR, 2.27; 95% CI, 1.53-3.38; P < .001). Very low-quality evidence showed IOH have a similar incidence of POCD (OR, 2.82; 95% CI, 0.83-9.50; P = .10) and 1-year-mortality (OR, 1.66; 95% CI, 0.65-4.20; P = .29) compared with non-IOH in non-cardiac surgery. Conclusion Our results suggest IOH was associated with an increased risk of severe postoperative complications after non-cardiac surgery than non-IOH. IOH is a potentially avoidable hazard that should be closely monitored during non-cardiac surgery.
Collapse
Affiliation(s)
- Jianghui Cai
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Mi Tang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
- Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Huaye Wu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jing Yuan
- Department of Information, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 611731, China
| | - Hua Liang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xuan Wu
- Department of Epidemiology and Biostatistics and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shasha Xing
- Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiao Yang
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiao-Dong Duan
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| |
Collapse
|
3
|
Czajka S, Putowski Z, Krzych ŁJ. Post-induction hypotension and intraoperative hypotension as potential separate risk factors for the adverse outcome: a cohort study. J Anesth 2023; 37:442-450. [PMID: 37083989 DOI: 10.1007/s00540-023-03191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Intraoperative hypotension (IOH) is associated with organ hypoperfusion. There are different underlying causes of IOH depending on the phase of surgery. Post-induction hypotension (PIH) and early-intraoperative hypotension tend to be frequently differentiated. We aimed to explore further different phases of IOH and verify whether they are differently associated with postoperative complications. METHODS Patients undergoing abdominal surgery between October 2018 and July 2019 in a university hospital were screened. Post-induction hypotension was defined as MAP ≤ 65 mmHg between the induction of anaesthesia and the onset of surgery. Hypotension during surgery (IOH) was defined as MAP ≤ 65 mmHg occurring between the onset of surgery and its completion. Acute kidney injury, stroke or transient ischaemic attack, delirium, and myocardial infarction were considered as the outcome. RESULTS We enrolled 508 patients (219 males, median age 62 years). 158 subjects (31.1%) met PIH, 171 (33.7%) met IOH criteria, and 67 (13.2%) patients experienced both. PIH time accounted for 22.8% of the total hypotension time and 29.7% of the IOH time. The IOH time accounted for 5.17% of the total intraoperative time, while PIH for 8.91% of the pre-incision time. Female sex, lower height, body mass and lower pre-induction BP (SBP and MAP) were found to be associated with the incidence of PIH. The negative outcome was observed in 38 (7.5%) patients. Intraoperative MAP ≤ 65 mmHg, longer duration of the procedure (≥ 230 min), chronic arterial hypertension and age were associated with the presence of the outcome (p < 0.01 each). CONCLUSIONS The presence of IOH defined as MAP ≤ 65 mmHg is relevant to post-operative organ complications, the presence of PIH does not appear to be of such significance. Because cumulative duration of PIH and IOH differs significantly, especially in long-lasting procedures, direct comparison of the influence of PIH and IOH on outcome separately may be biased and should be taken into account in data interpretation. Further research is needed to deeply investigate this phenomenon.
Collapse
Affiliation(s)
- Szymon Czajka
- Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, 14 Medykow Street, 40-752, Katowice, Poland.
| | - Zbigniew Putowski
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Łukasz J Krzych
- Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, 14 Medykow Street, 40-752, Katowice, Poland
| |
Collapse
|
4
|
Lee S, Park D, Ju JW, Bae J, Cho YJ, Nam K, Jeon Y. Relationship between intraoperative dopamine infusion and postoperative acute kidney injury in patients undergoing open abdominal aorta aneurysm repair. BMC Anesthesiol 2022; 22:82. [PMID: 35346048 PMCID: PMC8962567 DOI: 10.1186/s12871-022-01624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute kidney injury (AKI) is one of the most common complications in patients undergoing open abdominal aortic aneurysm (AAA) repair. Dopamine has been frequently used in these patients to prevent AKI. We aimed to clarify the relationship between intraoperative dopamine infusion and postoperative AKI in patients undergoing open AAA repair. Methods We analyzed 294 patients who underwent open AAA repair at a single tertiary center from 2009 to 2018, retrospectively. The primary outcome was the incidence of postoperative AKI, determined by the Kidney Disease Improving Global Outcomes definition, after open AAA repair. Secondary outcomes included survival outcome, hospital and intensive care unit length of stay, and postoperative renal replacement therapy (RRT). Results Postoperative AKI occurred in 21.8% (64 out of 294 patients) The risk of postoperative AKI by intraoperative dopamine infusion was greater after adjusting for risk factors (odds ratio [OR] 2.56; 95% confidence interval [CI], 1.09–5.89; P = 0.028) and after propensity score matching (OR 3.22; 95% CI 1.12–9.24; P = 0.030). On the contrary, intraoperative norepinephrine use was not associated with postoperative AKI (use vs. no use; 19.3 vs. 22.4%; P = 0.615). Patients who used dopamine showed higher requirement for postoperative RRT (6.8 vs. 1.2%; P = 0.045) and longer hospital length of stay (18 vs. 16 days, P = 0.024). Conclusions Intraoperative dopamine infusion was associated with more frequent postoperative AKI, postoperative RRT, and longer hospital length of stay in patients undergoing AAA repair, when compared to norepinephrine. Further prospective randomized clinical trial may be necessary for this topic. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01624-6.
Collapse
|
5
|
Obata Y, Kamijo-Ikemori A, Inoue S. Clinical Utility of Urinary Biomarkers for Prediction of Acute Kidney Injury and Chronic Renal Dysfunction After Open Abdominal Aortic Aneurysm Repair. Int J Nephrol Renovasc Dis 2021; 14:371-384. [PMID: 34557017 PMCID: PMC8455295 DOI: 10.2147/ijnrd.s322916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/03/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose We examined the clinical utility of perioperative monitoring of urinary liver-type fatty acid binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and albumin, for prediction of acute kidney injury (AKI) and prediction of chronic renal dysfunction in patients undergoing open surgical repair (OSR) of an abdominal aortic aneurysm. Patients and Methods Urine and serum samples were obtained perioperatively from 64 such patients (n=64). Patients in whom OSR-related AKI (defined by the Kidney Disease Improving Global Outcomes criteria) occurred were identified. Renal function was evaluated 3 years after OSR in patients with OSR-related AKI. Results The urinary biomarkers examined increased to maximum levels by 2 hours after aortic cross-clamping (AXC), regardless of whether AKI occurred. Notably, the serum creatinine (Cr) levels increased significantly immediately after OSR in patients with AKI (n=19) (vs that in patients without AKI). In patients with AKI, the increased serum Cr elevation rate, the urinary L-FABP levels 2 hours after AXC and immediately after OSR, and a reduction in eGFR documented 3 years after OSR were significantly greater in patients who underwent suprarenal AXC (n=11) than in those who underwent infrarenal AXC (n=8). Furthermore, urinary L-FABP levels 2 hours after AXC correlated significantly with the reductions in eGFR 3 years after OSR in patients with AKI. Conclusion Urinary L-FABP, NGAL and albumin concentrations 2 hours after AXC may be useful for early detection of OSR-related AKI. Furthermore, the increase in urinary L-FABP 2 hours after AXC may be predictive of chronic renal dysfunction in patients with OSR-related AKI.
Collapse
Affiliation(s)
- Yumi Obata
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Atsuko Kamijo-Ikemori
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| |
Collapse
|
6
|
Gregory A, Stapelfeldt WH, Khanna AK, Smischney NJ, Boero IJ, Chen Q, Stevens M, Shaw AD. Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery. Anesth Analg 2021; 132:1654-1665. [PMID: 33177322 PMCID: PMC8115733 DOI: 10.1213/ane.0000000000005250] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intraoperative hypotension (IOH) occurs frequently during surgery and may be associated with organ ischemia; however, few multicenter studies report data regarding its associations with adverse postoperative outcomes across varying hemodynamic thresholds. Additionally, no study has evaluated the association between IOH exposure and adverse outcomes among patients by various age groups.
Collapse
Affiliation(s)
- Anne Gregory
- From the Department of Critical Care Medicine, University of Alberta
| | - Wolf H Stapelfeldt
- Department of Anesthesiology & Critical Care Medicine, Saint Louis University
| | - Ashish K Khanna
- Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina.,Outcomes Research Consortium, Cleveland, Ohio
| | | | | | | | | | - Andrew D Shaw
- From the Department of Critical Care Medicine, University of Alberta.,Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta
| |
Collapse
|
7
|
Filiberto AC, Loftus TJ, Elder CT, Hensley S, Frantz A, Efron P, Ozrazgat-Baslanti T, Bihorac A, Upchurch GR, Cooper MA. Intraoperative hypotension and complications after vascular surgery: A scoping review. Surgery 2021; 170:311-317. [PMID: 33972092 DOI: 10.1016/j.surg.2021.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraoperative hypotension during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to intraoperative hypotension. This review summarizes current evidence regarding the impact of intraoperative hypotension on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure- and patient-specific risk factors. METHODS A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of intraoperative hypotension on patients undergoing vascular surgery. RESULTS Ninety-two studies met screening criteria; 9 studies met quality and inclusion criteria. Among the 9 studies that defined intraoperative hypotension objectively, there were 9 different definitions. Accordingly, the reported incidence of intraoperative hypotension ranged from 8% to 88% (when defined as a fall in systolic blood pressure of >30 mm Hg or mean arterial pressure <65). The results demonstrated that intraoperative hypotension is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of intraoperative hypotension. CONCLUSION There is no validated, consensus definition of intraoperative hypotension or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the weight of evidence suggests that intraoperative hypotension is common and associated with major postoperative complications in vascular surgery patients.
Collapse
Affiliation(s)
| | - Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL
| | - Craig T Elder
- Department of Surgery, University of Florida, Gainesville, FL
| | - Sara Hensley
- Department of Surgery, University of Florida, Gainesville, FL
| | - Amanda Frantz
- Department of Anesthesia, University of Florida, Gainesville, FL
| | - Phillip Efron
- Department of Surgery, University of Florida, Gainesville, FL
| | - Tezcan Ozrazgat-Baslanti
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL; Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL
| | - Azra Bihorac
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL; Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL
| | | | - Michol A Cooper
- Department of Surgery, University of Florida, Gainesville, FL.
| |
Collapse
|
8
|
Time-to-Event Analysis of the Impact of Endovascular Aortic Aneurysm Repair on Chronic Renal Decline. Ann Vasc Surg 2021; 74:165-175. [PMID: 33823250 DOI: 10.1016/j.avsg.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although randomized studies have revealed the long-term outcomes of the endovascular repair (ER) of abdominal aortic aneurysm (AAA) compared to open repair (OR), there is controversy surrounding chronic renal decline (CRD) after ER. This study reviewed our propensity-matched cohorts of ER and OR to compare CRD rates using a time-to-event analysis. The ER groups undergoing suprarenal (SR) or infrarenal (IR) proximal fixation were also compared with the OR group. METHODS This retrospective review of infrarenal AAA repair was conducted from June 2007-December 2017. Patients with ≥1 year of follow-up were included. Cases of supra/pararenal AAAs, infectious AAAs, rupture, or severe chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 or dependence on renal replacement therapy) were excluded. CRD was defined as eGFR decline of >20% or de novo hemodialysis during follow-up. Patients treated with ER (ER group) and OR (OR group) were propensity-score matched for age, sex, comorbidities, ejection fraction, respiratory function, and baseline eGFR. Kaplan-Meier analysis compared the freedom from CRD rates of the matched cohorts (mER and mOR groups). Patients treated with SR and IR fixation devices (SR and IR groups) were also separately matched to the OR group, followed by analysis. RESULTS In total, 1087 patients underwent elective AAA repair. Among them, 944 (512 ER and 432 OR) were enrolled. The ER group was older than the OR group (median age 79 vs 71; P<0.001). The ER group had significantly lower baseline eGFR and more comorbidities than the OR group. Among 187 propensity-score matched pairs (187 mER and 187 mOS patients), background characteristics, including age and baseline eGFR, were comparable, but median renal function follow-up was significantly longer in the mER group than in the mOR group (48 vs 26 months; P<0.001). CRD was observed in 57 patients in the mER group and 30 patients in the mOR group. Kaplan-Meier analysis of the freedom from CRD showed no significant difference between the matched groups (P=0.268); however, in the later follow-up of >4 years, CRD was more common in the mER group. The matched analyses between the OR group and specific fixation groups, comprising 102 OR-SR and 73 OR-IR pairs, demonstrated no significant differences in CRD. CONCLUSIONS Compared to OR, there was no significant impact of ER on CRD at up to 4 years, supporting the safety of ER in terms of the mid-term renal outcome of our present clinical practice.
Collapse
|
9
|
Wijnberge M, Schenk J, Bulle E, Vlaar AP, Maheshwari K, Hollmann MW, Binnekade JM, Geerts BF, Veelo DP. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open 2021; 5:6073395. [PMID: 33609377 PMCID: PMC7893468 DOI: 10.1093/bjsopen/zraa018] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality. Methods MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity. Results The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent. Conclusion Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic.
Collapse
Affiliation(s)
- M Wijnberge
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J Schenk
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E Bulle
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A P Vlaar
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Maheshwari
- Department of General Anaesthesiology, Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J M Binnekade
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B F Geerts
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - D P Veelo
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
10
|
The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure - an analysis of risk factors. Pol J Radiol 2020; 85:e643-e649. [PMID: 33552316 PMCID: PMC7857334 DOI: 10.5114/pjr.2020.102194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up. Material and methods A total of 214 endovascularly treated AAA patients were included. In all cases, pre- and postope-rative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years. Results The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m2. Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endo-vascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance. Conclusions Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.
Collapse
|
11
|
Shelton CL, Sutton R, White SM. Desflurane in modern anaesthetic practice: walking on thin ice(caps)? Br J Anaesth 2020; 125:852-856. [DOI: 10.1016/j.bja.2020.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/20/2023] Open
|
12
|
Chen Z, Hu Z, Hu Y, Sheng Y, Li Y, Song J. Novel Potential Biomarker of Adult Cardiac Surgery-Associated Acute Kidney Injury. Front Physiol 2020; 11:587204. [PMID: 33240107 PMCID: PMC7683426 DOI: 10.3389/fphys.2020.587204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Acute kidney injury (AKI) occurs in about 30% of patients with cardiac surgery, but the pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) remains unclear and there are no predictive biomarkers or diagnostic criteria specific for CSA-AKI beyond the general clinical variables for AKI like serum creatinine (SCr). Methods and Results We measured the plasma levels of 48 cytokines within 24 h after cardiac surgery in a total of 306 adult patients including 204 with and 102 without AKI, and then evaluated the diagnostic efficacy of these cytokines for the development of CSA-AKI via ANOVA and Pearson correlation analysis. Among these 48 cytokines, 20 of them were significantly different in the AKI patients compared with the non-AKI patients. In particularly, 13 cytokines displayed tremendous changes with the P < 1E–5. Moreover, 10 of the 48 cytokines in the plasma were significantly different among the patients with different stages of AKI. Specifically, 6 cytokines exhibited immense differences with the P < 1E–5. Additionally, 7 of the 48 cytokines have the correlation coefficient of r > 0.5 with the postoperative changes of SCr after cardiac surgery. Conclusion Taken all the results together, IFN-γ and SCGF-β were the most relevant two cytokines that were not only remarkably changed in adult CSA-AKI patients during the first 24 h after cardiac surgery, but also significantly correlated with the postoperative changes of SCr after cardiac surgery. Therefore, IFN-γ and SCGF-β might be novel predictive plasma biomarker, as well as potential therapeutic targets specific for adult CSA-AKI.
Collapse
Affiliation(s)
- Zujun Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengliang Hu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiqing Hu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixuan Sheng
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yuan Li
- State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
13
|
Rangasamy V, de Guerre L, Xu X, Schermerhorn ML, Novack V, Subramaniam B. Association Between Intraoperative Hypotension and Postoperative Adverse Outcomes in Patients Undergoing Vascular Surgery - A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2020; 35:1431-1438. [PMID: 33293215 DOI: 10.1053/j.jvca.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Intraoperative hypotension (IOH) is associated with adverse outcomes. It could be challenging to define IOH in vascular surgical patients with increased baseline blood pressure (BP). The authors studied the relationship between (1) absolute and relative BP thresholds of IOH, (2) preoperative pulse pressure (PP) and isolated systolic hypertension, and (3) endovascular versus open surgical approach with adverse outcomes in vascular surgical patients. DESIGN Retrospective observational study. SETTING Teaching hospital. PATIENTS A total of 566 vascular surgical patients from 2011 to 2018. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS BP thresholds were as follows: IOH - absolute mean arterial pressure (MAP) <65 mmHg, relative MAP >20% decrease from baseline, preoperative PP hypertension - PP >40 mmHg, isolated systolic hypertension - baseline systolic BP ≥140 mmHg with diastolic BP <90 mmHg. Thresholds were characterized by (1) total duration and (2) area under the curve. Primary outcome was a composite of postoperative in-hospital complications (acute kidney injury, stroke, myocardial infarction, congestive heart failure, and mortality). Forty-six (8.1%) patients had in-hospital complications. Only IOH duration-MAP <65 mmHg (odds ratio 1.01; 95% confidence interval 1.00-1.02; p = 0.004) was significantly associated with outcome. No associations were found with MAP >20% decrease from baseline and preoperative BP. Significant interaction was observed with the surgical approach and outcome (p = 0.031), which was stronger after 60 minutes of IOH in endovascular approach. CONCLUSION Longer periods of IOH (MAP <65 mmHg for >60 minutes) during endovascular surgery were associated with adverse outcomes. Relative fall in BP from baseline, preoperative isolated systolic, and PP hypertension were not associated with postoperative complications.
Collapse
Affiliation(s)
- Valluvan Rangasamy
- Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Livia de Guerre
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Xinling Xu
- Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc L Schermerhorn
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Balachundhar Subramaniam
- Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| |
Collapse
|
14
|
Dossabhoy SS, Simons JP, Crawford AS, Aiello FA, Judelson DR, Arous EJ, Messina LM, Schanzer A. Impact of acute kidney injury on long-term outcomes after fenestrated and branched endovascular aortic aneurysm repair. J Vasc Surg 2020; 72:55-65.e1. [DOI: 10.1016/j.jvs.2019.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
|
15
|
Baranauskas T, Kaunienė A, Švagždienė M, Širvinskas E, Lenkutis T. The correlation of post-operative acute kidney injury and perioperative anaemia in patients undergoing cardiac surgery with cardiopulmonary bypass. Acta Med Litu 2019; 26:79-86. [PMID: 31281220 DOI: 10.6001/actamedica.v26i1.3959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background and objective Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) is polyethiological clinical syndrome. During CPB haemodilution develops, which is useful in reducing the risk of thrombosis; however, haemodilutional anaemia decreases oxygen transfer and provokes tissue hypoxia, which can lead to acute organ damage. The aim of the study was to find out the impact of perioperative anaemia on AKI after cardiac surgery with CPB. Materials and methods This prospective study included 58 adult patients undergoing elective cardiac surgery with CPB, without any preoperative chronic renal disease or any systemic autoimmune disease. Serum concentrations of NGAL had been tested before the surgery, 2 hours, 6 hours, and one day after the surgery. Perioperative anaemia was assessed according to the Ht value before the surgery, the Ht value during CPB, and immediately after the surgery. Results The rate of haemodilutional anaemia is 77.59% in this study. The average of serum NGAL concentration before CPB was 63.95 ± 33.25 ng/mL and it was significantly lower than the average concentration 2 hours after the surgery, 6 hours after the surgery and one day after the surgery (respectively 148.51 ± 62.39, 119.44 ± 55, 128.70 ± 59.04 ng/mL, p < 0.05). AKI developed in 46.55% of the patients. A significant positive reasonable correlation between the development of perioperative anaemia and AKI was determined (r = 0.50, p < 0.05). Conclusions Post-operative AKI after cardiac surgery with CPB has a moderate positive correlation with perioperative haemodilutional anaemia. A longer CPB time and aortic cross-clamping time were found to be the risk factors for the development of AKI.
Collapse
Affiliation(s)
| | - Agnė Kaunienė
- Department of Internal Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Milda Švagždienė
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edmundas Širvinskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tadas Lenkutis
- Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
16
|
Al Adas Z, Shepard AD, Nypaver TJ, Weaver MR, Maatman T, Yessayan LT, Balraj P, Kabbani LS. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2018; 68:739-748. [DOI: 10.1016/j.jvs.2017.12.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
|
17
|
Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 2018; 69:752-762.e1. [PMID: 30154014 DOI: 10.1016/j.jvs.2018.05.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/17/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) is a common postoperative complication after abdominal aortic aneurysm (AAA) repair and is associated with significant morbidity and mortality. However, limited studies have investigated this complication in elderly patients. This study aims to evaluate AKI in octogenarians after open endovascular AAA repair (OAR) and endovascular AAA repair (EVAR). METHODS Data were obtained from the Vascular Quality Initiative database on all patients who underwent elective infrarenal AAA repair between January 2003 and April 2017. Univariate analysis was used to compare AKI rates as well as failure to rescue after AKI between octogenarians and nonoctogenarians in OAR and EVAR. Stepwise multivariable logistic regression analysis was implemented to identify independent predictors and develop a risk calculator of AKI in octogenarians undergoing AAA repair. RESULTS A total of 27,993 patients (12% OAR and 88% EVAR) were included, of which 6708 (24%) were octogenarians (OAR, 332; EVAR, 6376). Postoperative AKI was more common in octogenarians as compared with nonoctogenarians in OAR (15.1% vs 10.1%; P = .01) and EVAR (4.2% vs 2.7%; P < .001). Similarly, failure to rescue, defined as 30-day mortality after postoperative AKI, was higher in octogenarians whether undergoing OAR (28.0% vs 8.8%; P < .001) or EVAR (14.1% vs 7.5%; P < .01). On multivariable analysis, octogenarians undergoing OAR had a 3.5 times higher odds of AKI compared with those undergoing EVAR (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.36-5.23; P < .001). Other independent risk factors for postoperative AKI in octogenarians included chronic obstructive pulmonary disease (OR, 1.48; 95% CI, 1.14-1.93), chronic kidney disease stage III (OR, 2.17; 95% CI, 1.26-3.76) and chronic kidney disease stage IV-V (OR, 5.7; 95% CI, 3.0-10.9), peripheral artery disease (OR, 1.99; 95% CI, 1.34-2.94), preoperative β-blocker use (OR, 1.85; 95% CI, 1.45-2.38), and aneurysm diameter (OR, 1.25; 95% CI, 1.11-1.41). These predictors were incorporated in an interactive risk calculator of AKI after AAA repair in octogenarians (C-statistic = 0.728). CONCLUSIONS AKI is a serious complication after AAA repair, especially in octogenarians, and is associated with high failure to rescue rates. A careful assessment of risk factors for AKI in elderly patients should be performed to inform clinical decision making.
Collapse
|
18
|
Gombert A, Prior I, Martin L, Grommes J, Barbati ME, Foldenauer AC, Schälte G, Marx G, Schürholz T, Greiner A, Jacobs MJ, Kalder J. Urine neutrophil gelatinase-associated lipocalin predicts outcome and renal failure in open and endovascular thoracic abdominal aortic aneurysm surgery. Sci Rep 2018; 8:12676. [PMID: 30140016 PMCID: PMC6107559 DOI: 10.1038/s41598-018-31183-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022] Open
Abstract
Urine neutrophil gelatinase–associated lipocalin (uNGAL) has been evaluated as a biomarker for AKI detection and adverse outcome in open and endovascular thoracoabdominal aortic aneurysm surgery. This observational, retrospective study included 52 patients. UNGAL was measured peri-operatively (48 h) and correlated with AKI requiring dialysis, tracheotomy and adverse outcome. Mean patients’ age was 64.5 years. A total of 26.9% (n = 14) developed AKI, and 21.1% (n = 11) required dialysis, tracheotomy rate was 19.2% (n = 10) and in-hospital mortality rate was 7.6% (n = 4). uNGAL levels were related to AKI requiring dialysis at ICU (p = 0.0002), need for tracheotomy at baseline and admission on ICU (p = 0.0222, p = 0.0028, respectively), as well as adverse discharge modality (p = 0.0051, p = 0.0048, respectively). Diagnostic quality was good for uNGAL levels at admission to ICU regarding AKI requiring dialysis (sensitivity: 81.8% [48.2–97.7]; specificity: 87.8% [73.8–95.9]; area under the curve (AUC): 0.874 [0.752–0.949]). The diagnostic quality of uNGAL was favorable for the prediction of tracheotomy (sensitivity: 70.0% [34.8–93.3]; specificity: 83.3% [68.6–93.0]; AUC: 0.807 [0.674–0.903]) and adverse discharge (sensitivity: 77.8% [40.0–97.2]; specificity: 83.7% [69.3–93.2]; AUC: 0.817 [0.685–0.910]). uNGAL may be valuable as an post-operative predictor of AKI and adverse outcome after open and endovascular TAAA repair.
Collapse
Affiliation(s)
- A Gombert
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany.
| | - I Prior
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - L Martin
- Department of Intensive Care and Intermediate Care, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - J Grommes
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - M E Barbati
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - A C Foldenauer
- Department of Medical Statistics, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - G Schälte
- Department of Anesthesiology, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - G Marx
- Department of Intensive Care and Intermediate Care, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - T Schürholz
- Department of Anaesthesia and Intensive Care, University of Rostock, Rostock, Germany
| | - A Greiner
- Department of Vascular Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - M J Jacobs
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| | - J Kalder
- European Vascular Center Aachen, University Hospital Aachen, RWTH Aachen University, Maastricht, Germany
| |
Collapse
|
19
|
Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth 2018; 121:706-721. [PMID: 30236233 DOI: 10.1016/j.bja.2018.04.036] [Citation(s) in RCA: 421] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/04/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intraoperative hypotension is a common side effect of general anaesthesia and might lead to inadequate organ perfusion. It is unclear to what extent hypotension during noncardiac surgery is associated with unfavourable outcomes. METHODS We conducted a systematic search in PubMed, Embase, Web of Science, and CINAHL, and classified the quality of retrieved articles according to predefined adapted STROBE and CONSORT criteria. Reported strengths of associations from high-quality studies were classified into end-organ specific injury risks, such as acute kidney injury, myocardial injury, and stroke, and overall organ injury risks for various arterial blood pressure thresholds. RESULTS We present an overview of 42 articles on reported associations between various absolute and relative intraoperative hypotension definitions and their associations with postoperative adverse outcomes after noncardiac surgery. Elevated risks of end-organ injury were reported for prolonged exposure (≥10 min) to mean arterial pressures <80 mm Hg and for shorter durations <70 mm Hg. Reported risks increase with increased durations for mean arterial pressures <65-60 mm Hg or for any exposure <55-50 mm Hg. CONCLUSIONS The reported associations suggest that organ injury might occur when mean arterial pressure decreases <80 mm Hg for ≥10 min, and that this risk increases with blood pressures becoming progressively lower. Given the retrospective observational design of the studies reviewed, reflected by large variability in patient characteristics, hypotension definitions and outcomes, solid conclusions on which blood pressures under which circumstances are truly too low cannot be drawn. We provide recommendations for the design of future studies. CLINICAL REGISTRATION NUMBER: (PROSPERO ID). CRD42013005171.
Collapse
Affiliation(s)
- E M Wesselink
- Department of Anesthesiology, Utrecht, The Netherlands.
| | - T H Kappen
- Department of Anesthesiology, Utrecht, The Netherlands
| | - H M Torn
- Department of Anesthesiology, Utrecht, The Netherlands
| | - A J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W A van Klei
- Department of Anesthesiology, Utrecht, The Netherlands
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW In this review, we discuss the latest updates on perioperative acute kidney injury (AKI) and the specific considerations that are relevant to different surgeries and patient populations. RECENT FINDINGS AKI diagnosis is constantly evolving. New biomarkers detect AKI early and shed a light on the possible cause of AKI. Hypotension, even for a short duration, is associated with perioperative AKI. The debate on the deleterious effects of chloride-rich solutions is still far from conclusion. Remote ischemic preconditioning is showing promising results in the possible prevention of perioperative AKI. No definite data show a beneficiary effect of statins, fenoldepam, or sodium bicarbonate in preventing AKI. SUMMARY Perioperative AKI is prevalent and associated with significant morbidity and mortality. Considering the lack of effective preventive or therapeutic interventions, this review focuses on perioperative AKI: measures for early diagnosis, defining risks and possible mechanisms, and summarizing current knowledge for intraoperative fluid and hemodynamic management to reduce risk of AKI.
Collapse
|
21
|
Rampoldi B, Tessarolo S, Giubbilini P, Gaia P, Corino SD, Mazza S, Rigolini R, Poli MD, Vianello E, Romanelli MMC, Costa E. Neutrophil gelatinase-associated lipocalin and acute kidney injury in endovascular aneurysm repair or open aortic repair: a pilot study. Biochem Med (Zagreb) 2018; 28:010904. [PMID: 29472806 PMCID: PMC5806618 DOI: 10.11613/bm.2018.010904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR). Materials and methods Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline. Results Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) vs AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 - 263) ng/mL for bNGAL, P = 0.029). Conclusions Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI.
Collapse
Affiliation(s)
- Benedetta Rampoldi
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Serena Tessarolo
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Giubbilini
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Gaia
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Samantha D Corino
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Sarah Mazza
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Dei Poli
- Intensive Care Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano M Corsi Romanelli
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elena Costa
- Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| |
Collapse
|
22
|
Zabrocki L, Marquardt F, Albrecht K, Herget-Rosenthal S. Acute kidney injury after abdominal aortic aneurysm repair: current epidemiology and potential prevention. Int Urol Nephrol 2017; 50:331-337. [DOI: 10.1007/s11255-017-1767-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/06/2017] [Indexed: 01/20/2023]
|
23
|
Liu YY, Xue FS, Wen C, Yang GZ. Use of V-POSSUM and E-PASS Scores to Predict Acute Kidney Injury after Elective Open Abdominal Aortic Aneurysm Surgery. Ann Vasc Surg 2017; 45:337. [PMID: 28887266 DOI: 10.1016/j.avsg.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Chao Wen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
24
|
Estimation of V-POSSUM and E-PASS Scores in Prediction of Acute Kidney Injury in Patients after Elective Open Abdominal Aortic Aneurysm Surgery. Ann Vasc Surg 2017; 42:189-197. [PMID: 28359795 DOI: 10.1016/j.avsg.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND V-POSSUM and E-PASS scoring systems are usually used to predict morbidity and early mortality in surgical patients. We conducted this study to assess the validity of the V-POSSUM and E-PASS scores in predicting risk of acute kidney injury (AKI) development in patients undergoing elective open abdominal aortic aneurysm (AAA) repair. METHODS We studied a consecutive series of 171 patients with AAA, qualified for elective open infrarenal repair. Patients underwent a thorough examination, and the physiological and surgical stress components of the V-POSSUM and E-PASS scores were calculated. The classification of patients in terms of postoperative AKI was performed in accordance with KDIGO criteria. RESULTS AKI was recognized in 62 patients. In these patients, we found significantly higher physiological and surgical stress components of V-POSSUM and E-PASS scores in relation to patients without AKI. ROC analysis showed that the E-PASS score with a cutoff point ≥0.796 and the V-POSSUM score (morbidity) with a cutoff point ≥77.2% with sensitivity of 75.8% and 74.2%, respectively, and with specificity of 83.5% for both, identified patients with postoperative AKI. CONCLUSIONS V-POSSUM and E-PASS scores have similar good properties in predicting postoperative AKI in patients undergoing elective open AAA repair.
Collapse
|
25
|
Acute Kidney Injury after Open Repair of Intact Abdominal Aortic Aneurysms. Ann Vasc Surg 2017; 39:294-300. [DOI: 10.1016/j.avsg.2016.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/08/2016] [Accepted: 09/05/2016] [Indexed: 12/29/2022]
|
26
|
Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms. J Vasc Surg 2016; 64:928-933.e1. [DOI: 10.1016/j.jvs.2016.02.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 11/23/2022]
|
27
|
Penugonda LC, Saththasivam P, Green MS. A Successful Repair of a Giant Abdominal Aortic Aneurism. Anesth Pain Med 2016; 6:e34847. [PMID: 27642578 PMCID: PMC5018132 DOI: 10.5812/aapm.34847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/19/2016] [Accepted: 02/14/2016] [Indexed: 01/24/2023] Open
Affiliation(s)
- Lakshmi C Penugonda
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA
| | - Poovendran Saththasivam
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA
| | - Michael Stuart Green
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA
- Corresponding author: Michael Stuart Green, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA. Tel: +215-7621524, Fax: +215-7628656, E-mail:
| |
Collapse
|