1
|
Zhang SJ, Fang TF, Lin MY, Shu NN, Zhou M, Gu HB, Dan YZ, Lu GL. Risk factors for acute kidney injury in preterm neonates after noncardiac surgery: a single-center retrospective cohort study. Sci Rep 2024; 14:17965. [PMID: 39095375 PMCID: PMC11297254 DOI: 10.1038/s41598-024-67782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
Postoperative acute kidney injury (AKI) is a common complication that is associated with chronic kidney disease, early postsurgical mortality, and prolonged hospital stays. Preterm neonates who undergo surgery are at risk factors for AKI due to underdeveloped kidneys. To date, little is known about the incidence and perioperative risk factors for AKI in preterm neonates undergoing noncardiac surgery. Preterm neonates who underwent noncardiac surgery between January May 1, 2020, and February 28, 2023, were enrolled in the trial according to the inclusion criteria. Both multivariable and logistic regression analyses were used to analyze the associations between characteristic data and AKI. In total, 106 preterm neonates met the inclusion criteria, and 25 preterm neonates (23.6%) developed postoperative AKI. Multivariate analysis revealed that the factors associated with AKI were gestational age < 32 weeks [OR: 4.88; 95% CI (1.23-19.42)], preoperative sepsis [OR: 3.98; 95% CI (1.29-12.28)], and intraoperative hypotension [OR: 3.75; 95% CI (1.26-11.15)]. Preterm neonates who developed AKI were more likely to have longer hospital length of stays (38 [18,69] days vs. 21[12,46]) and higher medical costs (93,181.6 [620450.0,173,219.0] ¥ vs. 58,134.6 [31015.1,97,224,1) ¥ than neonates who did not develop AKI. Preterm neonates who underwent noncardiac surgery had a high incidence of AKI. Independent risk factors for AKI in preterm neonates who underwent noncardiac surgery were low gestational age, preoperative sepsis, and intraoperative hypotension. Preterm neonates who developed AKI were more likely to have longer hospital stays and higher medical costs.
Collapse
Affiliation(s)
- Su-Jing Zhang
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tuan-Fang Fang
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min-Yi Lin
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Nan-Nan Shu
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong-Bin Gu
- Department of Anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Zhi Dan
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Lin Lu
- Department of Anesthesiology, Fujian Children's Hospital, (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
2
|
Penev Y, Ruppert MM, Bilgili A, Li Y, Habib R, Dozic AV, Small C, Adiyeke E, Ozrazgat-Baslanti T, Loftus TJ, Giordano C, Bihorac A. Intraoperative hypotension and postoperative acute kidney injury: A systematic review. Am J Surg 2024; 232:45-53. [PMID: 38383166 DOI: 10.1016/j.amjsurg.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND There is no consensus regarding safe intraoperative blood pressure thresholds that protect against postoperative acute kidney injury (AKI). This review aims to examine the existing literature to delineate safe intraoperative hypotension (IOH) parameters to prevent postoperative AKI. METHODS PubMed, Cochrane Central, and Web of Science were systematically searched for articles published between 2015 and 2022 relating the effects of IOH on postoperative AKI. RESULTS Our search yielded 19 articles. IOH risk thresholds ranged from <50 to <75 mmHg for mean arterial pressure (MAP) and from <70 to <100 mmHg for systolic blood pressure (SBP). MAP below 65 mmHg for over 5 min was the most cited threshold (N = 13) consistently associated with increased postoperative AKI. Greater magnitude and duration of MAP and SBP below the thresholds were generally associated with a dose-dependent increase in postoperative AKI incidence. CONCLUSIONS While a consistent definition for IOH remains elusive, the evidence suggests that MAP below 65 mmHg for over 5 min is strongly associated with postoperative AKI, with the risk increasing with the magnitude and duration of IOH.
Collapse
Affiliation(s)
- Yordan Penev
- Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | - Matthew M Ruppert
- Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | - Ahmet Bilgili
- Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | - Youlei Li
- University of Florida, Gainesville, FL, USA
| | | | | | - Coulter Small
- Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | - Esra Adiyeke
- Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | | | - Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA
| | - Chris Giordano
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
3
|
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
|
4
|
Acute Kidney Injury and Renal Replacement Therapy: A Review and Update for the Perioperative Physician. Anesthesiol Clin 2023; 41:211-230. [PMID: 36872000 DOI: 10.1016/j.anclin.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Post-operative acute kidney injury is a devastating complication with significant morbidity and mortality associated with it. The perioperative anesthesiologist is in a unique position to potentially mitigate the risk of postoperative AKI, however, understanding the pathophysiology, risk factors and preventative strategies is paramount. There are also certain clinical scenarios, where renal replacement therapy may be indicated intraoperatively including severe electrolyte abnormalities, metabolic acidosis and massive volume overload. A multidisciplinary approach including the nephrologist, critical care physician, surgeon and anesthesiologist is necessary to determine the optimal management of these critically ill patients.
Collapse
|
5
|
Ripollés-Melchor J, Zorrilla-Vaca A, Lorente JV, Weiss R. Is it time to incorporate Kidney Disease Improving Global Outcomes (KDIGO) bundles into Enhanced Recovery After Surgery (ERAS) protocols for colorectal surgery? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:125-128. [PMID: 36842696 DOI: 10.1016/j.redare.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/30/2021] [Indexed: 02/28/2023]
Affiliation(s)
- J Ripollés-Melchor
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM); Fluid Therapy and Hemodynamic Group of the Hemostasis, Transfusion Medicine and Fluid Therapy Section, Spanish Society of Anesthesia and Critical Care (SEDAR).
| | - A Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J V Lorente
- Fluid Therapy and Hemodynamic Group of the Hemostasis, Transfusion Medicine and Fluid Therapy Section, Spanish Society of Anesthesia and Critical Care (SEDAR); Department of Anesthesia and Critical Care, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - R Weiss
- Department of Anesthesia and Critical Care, Juan Ramón Jiménez Hospital, Huelva, Spain; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany; Renal Protection Network, RAPNET
| |
Collapse
|
6
|
Mahran MMA, Sabry Ahmed AM, Aly Mohamed AY, Khalifa Elsayed AF. Early prediction of acute kidney injury with cell cycle arrest biomarkers using plethesmography directed fluid management in major abdominal surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2096302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
7
|
Lambert DH. Myocardial and Acute Kidney Injury Associated With Hypotension: Is It Associated With the Depth of Anesthesia and Compensatory Vasopressor Use? Anesth Analg 2022; 134:e16-e18. [PMID: 35299219 DOI: 10.1213/ane.0000000000005894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Donald H Lambert
- Anesthesiologist, Department of Anesthesiology, Boston Medical Center, Professor of Anesthesiology, Boston University School of Medicine, Boston, Massachusetts,
| |
Collapse
|