Intraoperative Hypotension and Acute Kidney Injury in Non-cardiac Surgery at a Large Tertiary Care Medical Center

AANA J. 2022 Feb;90(1):58-63.

Abstract

Acute kidney injury (AKI) is a serious postoperative complication that increases patients' risk for long- and shortterm morbidity and mortality. Risk for developing AKI increases following intraoperative hypotension (IOH). This project aimed to describe the rate of and establish IOH as an independent risk factor for AKI among adults undergoing non-cardiac surgery at a large tertiary care medical center. An observational, retrospective, evidence-based practice project was conducted. Records were extracted for adults undergoing general anesthesia for non-cardiac surgery from 2015 to 2019 with available serum creatinine laboratory results. The primary project outcome was postoperative AKI. Among 4,603 cases, 8.9% experienced postoperative AKI. Cases with IOH (MAPs less than 60 mmHg for at least 10 minutes) compared to cases without IOH had increased risks for AKI (RR 1.48, 95% CI [1.19-1.84], P<.001). In a fully adjusted model, IOH was an independent risk factor for AKI (OR 1.50, 95% CI [1.18-1.92], P=.001). Among cases with serum creatinine laboratory results, the rate of AKI was higher than reported literature rates. IOH was confirmed as an independent risk factor. Quantifying the rate of and risk factors for AKI may precipitate heightened attention to prevention strategies and encourage quality improvement initiatives.

Keywords: Anesthesiology; acute kidney injury; intraoperative hypotension; mean arterial blood pressure.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury* / diagnosis
  • Acute Kidney Injury* / epidemiology
  • Acute Kidney Injury* / etiology
  • Adult
  • Humans
  • Hypotension* / epidemiology
  • Hypotension* / etiology
  • Intraoperative Complications / diagnosis
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / etiology
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Tertiary Healthcare