The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis

Anaesthesia
Kamal MaheshwariAndrea Kurz

Abstract

Intra-operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non-cardiac surgery. Intra-operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0-14.7 [0.0-60.0]) min.h-1 before skin incision, compared with 1.7 [0.3-5.1 [0.0-57.5]) min.h-1 after incision: a median (IQR [range]) of 36% (0%-84% [0%-100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02-1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before sk...Continue Reading

References

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Citations

Jul 25, 2019·The Journal of Trauma and Acute Care Surgery·Nathan Jerome SmischneyPhilippe R Bauer
Dec 14, 2019·Current Opinion in Anaesthesiology·Katherine KozarekDiane Head
Jan 30, 2020·Seminars in Cardiothoracic and Vascular Anesthesia·Guy E EfuneUNKNOWN Society for the Advancement of Transplant Anesthesia Research Committee Writing Group
Sep 1, 2020·PloS One·Nathan J SmischneyUNKNOWN SCCM Discovery (Critical Care Research Network of Critical Care Medicine) HEMAIR Investigators Consortium
Aug 20, 2019·Journal of Anesthesia·Ryohei MiyazakiKen Yamaura
Nov 28, 2019·Indian Journal of Anaesthesia·Jaap J Vos, Thomas W L Scheeren
Apr 17, 2020·Der Anaesthesist·M WelteD A Reuter
Dec 4, 2019·Anesthesiology·Michael R MathisUNKNOWN Multicenter Perioperative Outcomes Group Investigators
Mar 7, 2020·Indian Journal of Anaesthesia·Karim KouzBernd Saugel
May 27, 2020·Anesthesiology Research and Practice·Nathan J SmischneyMohammad H Murad
Jan 25, 2020·Journal of Clinical Monitoring and Computing·Ilonka N de KeijzerThomas W L Scheeren
Feb 11, 2021·Biomedizinische Technik. Biomedical Engineering·Alexandru-Gabriel PielmusSebastian Zaunseder
Nov 19, 2020·Anesthesiology·Bernd Saugel, Daniel I Sessler
Oct 17, 2020·International Anesthesiology Clinics·Howard LeeBobbie Jean Sweitzer
Oct 14, 2020·British Journal of Anaesthesia·Friederike C AlthoffMatthias Eikermann
Mar 30, 2021·Frontiers in Veterinary Science·Alexander Valverde
Jan 13, 2019·Anaesthesia Critical Care & Pain Medicine·Matthieu Biais, Rupert Pearse
May 27, 2021·Case Reports in Anesthesiology·Tomoe SatohMichiaki Yamakage

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