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Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study.
Putowski, Zbigniew; Majewska, Karolina; Gruca, Karol; Zimnoch, Aleksandra; Szczepanska, Anna; Krzych, Lukasz J; Jablonska, Beata; Mrowiec, Slawomir.
Afiliación
  • Putowski Z; Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Majewska K; Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Gruca K; Students' Scientific Society, Department of Digestive Tract Surgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Zimnoch A; Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Szczepanska A; Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Krzych LJ; Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Jablonska B; Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
  • Mrowiec S; Department of Digestive Tract Surgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Med Sci Monit ; 29: e938945, 2023 Apr 11.
Article en En | MEDLINE | ID: mdl-37038338
BACKGROUND Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to postoperative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who underwent PD and evaluated IOH as a factor associated with AKI. MATERIAL AND METHODS We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO criteria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean arterial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regression models with previously established independent variables. RESULTS We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. CONCLUSIONS In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesión Renal Aguda / Hipotensión Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Med Sci Monit Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesión Renal Aguda / Hipotensión Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Med Sci Monit Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Estados Unidos