Martins Lima Patrícia, Ferreira Luana, Dias Ana Lídia, Rodrigues Diana, Abelha Fernando, Mourão Joana
Department of Anesthesiology, Unidade Local de Saúde São João, Porto, PRT.
Center for Research in Health Technologies and Health Systems (CINTESIS), Faculty of Medicine of Porto, Porto, PRT.
Cureus. 2024 Jul 15;16(7):e64579. doi: 10.7759/cureus.64579. eCollection 2024 Jul.
Background Reportedly prevalent, intraoperative hypotension (IOH) is linked to kidney injury and increased risk of mortality. In this study, we aimed to assess IOH incidence in high-risk non-cardiac surgery and its correlation with postoperative acute kidney injury (PO-AKI) and 30-day postoperative mortality. Methodology This retrospective cohort study included adult inpatients who underwent elective, non-cardiac, high-risk European Society of Anaesthesiology/European Society of Cardiology surgery from October to November of 2020, 2021, and 2022, excluding cardiac, intracranial, or emergency surgery. IOH was primarily defined by the 2022 Anesthesia Quality Institute. PO-AKI was defined as an increase in serum creatinine ≥0.3 mg/dL within 48 hours, the need for dialysis in dialysis-naïve patients, or the documentation of AKI in clinical records. For univariate analysis, the Mann-Whitney U test and chi-square or Fisher's exact tests were performed, as appropriate. Logistic regression was used to test risk factors for IOH in univariate analysis (p < 0.1). The significance level considered in multivariate analysis was 5%. Results Of the 197 patients included, 111 (56.3%) experienced IOH. After adjustment, surgical time >120 minutes remained associated with higher odds of IOH (odds ratio (OR) = 9.62, 95% confidence interval (CI) = 2.49-37.13), as well as combined general + locoregional (vs. general OR = 3.41, 95 CI% = 1.38-8.43, p = 0.008; vs. locoregional OR = 6.37, 95% CI = 1.48-27.47). No association was found between IOH and 30-day postoperative mortality (p = 0.565) or PO-AKI (p = 0.09). The incidence of PO-AKI was 14.9% (27 patients), being significantly associated with higher 30-day postoperative mortality (p = 0.018). Conclusions Our study highlights the high prevalence of IOH in high-risk non-cardiac surgical procedures. Its impact on PO-AKI and 30-day postoperative mortality appears less pronounced compared to the significant implications of PO-AKI, emphasizing the need for PO-AKI screening and renal protection strategies.
背景 据报道，术中低血压（IOH）很常见，与肾损伤及死亡风险增加有关。在本研究中，我们旨在评估高危非心脏手术中IOH的发生率及其与术后急性肾损伤（PO-AKI）和术后30天死亡率的相关性。方法 这项回顾性队列研究纳入了2020年10月至11月、2021年和2022年接受择期、非心脏、高危欧洲麻醉学会/欧洲心脏病学会手术的成年住院患者，排除心脏、颅内或急诊手术。IOH主要根据2022年麻醉质量研究所的定义。PO-AKI定义为48小时内血清肌酐升高≥0.3mg/dL、未接受透析治疗的患者需要透析或临床记录中有AKI的记录。单因素分析时，酌情进行Mann-Whitney U检验和卡方检验或Fisher精确检验。在单因素分析中使用逻辑回归检验IOH的危险因素（p<0.1）。多因素分析中的显著性水平为5%。结果 在纳入的197例患者中，111例（56.3%）发生了IOH。调整后，手术时间>120分钟仍然与IOH的较高几率相关（比值比（OR）=9.62，95%置信区间（CI）=2.49-37.13），以及全身麻醉+区域麻醉联合使用（与全身麻醉相比，OR=3.41，95%CI=1.38-8.43，p=0.008；与区域麻醉相比，OR=6.37，95%CI=1.48-27.47）。未发现IOH与术后30天死亡率（p=0.565）或PO-AKI（p=0.09）之间存在关联。PO-AKI的发生率为14.9%（27例患者），与术后30天较高的死亡率显著相关（p=0.018）。结论 我们的研究突出了IOH在高危非心脏手术中的高发生率。与PO-AKI的显著影响相比，其对PO-AKI和术后30天死亡率的影响似乎不那么明显，强调了PO-AKI筛查和肾脏保护策略的必要性。
