Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study

Andrew D Shaw; Ashish K Khanna; Nathan J Smischney; Apeksha V Shenoy; Isabel J Boero; Michael Bershad; Seungyoung Hwang; Qinyu Chen; Wolf H Stapelfeldt

doi:10.1016/j.bja.2022.03.027

Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study

Br J Anaesth. 2022 Jul;129(1):13-21. doi: 10.1016/j.bja.2022.03.027. Epub 2022 May 18.

Authors

Andrew D Shaw¹, Ashish K Khanna², Nathan J Smischney³, Apeksha V Shenoy⁴, Isabel J Boero⁵, Michael Bershad⁶, Seungyoung Hwang⁴, Qinyu Chen⁵, Wolf H Stapelfeldt⁷

Affiliations

¹ Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA. Electronic address: shawa8@ccf.org.
² Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
³ Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Boston Strategic Partners, Boston, MA, USA.
⁵ Boston Consulting Group, Boston, MA, USA.
⁶ Edwards Lifesciences, Irvine, CA, USA.
⁷ Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA; Anesthesiology Services, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.

PMID: 35595549
DOI: 10.1016/j.bja.2022.03.027

Abstract

Background: Whilst intraoperative hypotension is associated with postoperative acute kidney injury (AKI), the link between intraoperative hypotension and acute kidney disease (AKD), defined as continuing renal dysfunction for up to 3 months after exposure, has not yet been studied.

Methods: We conducted a retrospective multicentre cohort study using data from noncardiac, non-obstetric surgery extracted from a US electronic health records database. Primary outcome was the association between intraoperative hypotension, at three MAP thresholds (≤75, ≤65, and ≤55 mm Hg), and the following two AKD subtypes: (i) persistent (initial AKI incidence within 7 days of surgery, with continuation between 8 and 90 days post-surgery) and (ii) delayed (renal impairment without AKI within 7 days, with AKI occurring between 8 and 90 days post-surgery). Secondary outcomes included healthcare resource utilisation for patients with either AKD subtype or no AKD.

Results: A total of 112 912 surgeries qualified for the study. We observed a rate of 2.2% for delayed AKD and 0.6% for persistent AKD. Intraoperative hypotension was significantly associated with persistent AKD at MAP ≤55 mm Hg (hazard ratio 1.1; 95% confidence interval: 1.38-1.22; P<0.004). However, IOH was not significantly associated with delayed AKD across any of the MAP thresholds. Patients with delayed or persistent AKD had higher healthcare resource utilisation across both hospital and intensive care admissions, compared with patients with no AKD.

Conclusions: Intraoperative hypotension is associated with persistent but not delayed acute kidney disease. Both types of acute kidney disease appear to be associated with increased healthcare utilisation. Correction of intraoperative hypotension is a potential opportunity to decrease postoperative kidney injury and associated costs.

Keywords: acute kidney disease; acute kidney injury; electronica heath record database; healthcare resource utilisation; intraoperative hypotension; mean arterial pressure; noncardiac surgery.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Cohort Studies
Humans
Hypotension* / epidemiology
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies