Intraoperative hypotension and postoperative acute kidney injury: A systematic review

Yordan Penev; Matthew M Ruppert; Ahmet Bilgili; Youlei Li; Raiya Habib; Abdul-Vehab Dozic; Coulter Small; Esra Adiyeke; Tezcan Ozrazgat-Baslanti; Tyler J Loftus; Chris Giordano; Azra Bihorac

doi:10.1016/j.amjsurg.2024.02.001

Intraoperative hypotension and postoperative acute kidney injury: A systematic review

Am J Surg. 2024 Feb 16:S0002-9610(24)00062-X. doi: 10.1016/j.amjsurg.2024.02.001. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA.
² University of Florida, Gainesville, FL, USA.
³ Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA.
⁴ Department of Surgery, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA.
⁵ Department of Anesthesiology, University of Florida, Gainesville, FL, USA.
⁶ Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA. Electronic address: abihorac@ufl.edu.

PMID: 38383166
DOI: 10.1016/j.amjsurg.2024.02.001

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.

Keywords: AKI; Acute kidney injury; Intraoperative hemodynamics; Intraoperative hypotension; Postoperative complications; Surgery complications.

Publication types

Review