Intraoperative renal desaturation and postoperative acute kidney injury in older patients undergoing liver resection: A prospective cohort study
Yao Yu, Haotian Wu, Chang Liu, Changsheng Zhang, Yuxiang Song, Yulong Ma, Hao Li, Jingsheng Lou, Yanhong Liu, Jiangbei Cao, Huan Zhang, Zhipeng Xu, Roger G Evans, Chongyang Duan, Weidong Mi, Yao Yu, Haotian Wu, Chang Liu, Changsheng Zhang, Yuxiang Song, Yulong Ma, Hao Li, Jingsheng Lou, Yanhong Liu, Jiangbei Cao, Huan Zhang, Zhipeng Xu, Roger G Evans, Chongyang Duan, Weidong Mi
Abstract
Study objective: To determine the association between intraoperative renal tissue desaturation as measured using near-infrared spectroscopy and increased likelihood of developing postoperative acute kidney injury (AKI) in older patients undergoing hepatectomy.
Design: A multicenter prospective cohort study.
Setting: The study was conducted at two tertiary hospitals in China from September 2020 to October 2021.
Patients: 157 older patients (≥ 60 years) undergoing open hepatectomy surgery.
Interventions and measurements: Renal tissue oxygen saturation was continuously monitored during operation using near-infrared spectroscopy. The exposure of interest was intraoperative renal desaturation, defined as at least 20% relative decline in renal tissue oxygen saturation from baseline. The primary outcome was postoperative AKI, defined using the Kidney Disease: Improving Global Outcomes criteria according to the serum creatinine criteria.
Main results: Renal desaturation occurred in 70 of 157 patients. Postoperative AKI was observed in 23% (16/70) and 8% (7/87) of patients with versus without renal desaturation. Patients with renal desaturation were at higher risk of AKI than patients without renal desaturation (adjusted odds ratio 3.41, 95% confidence interval: 1.12-10.36, p = 0.031). Predictive performance was 65.2% sensitivity and 33.6% specificity for hypotension alone, 69.6% sensitivity and 59.7% specificity for renal desaturation alone, and 95.7% sensitivity and 26.9% specificity for combined use of hypotension and renal desaturation.
Conclusions: Intraoperative renal desaturation occurred in >40% in our sample of older patients undergoing liver resection and was associated with increased risk of AKI. Intraoperative near-infrared spectroscopy monitoring enhances the detection of AKI.
Keywords: Hepatectomy; Postoperative acute kidney injury; Renal desaturation; Renal oxygen saturation.
Conflict of interest statement
Declaration of Competing Interest None.
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed