The role of intraoperative parameters on predicting laparoscopic abdominal surgery associated acute kidney injury

Abstract

Background: Laparoscopic abdominal surgery has been widely used to reduce the length of hospital stay and complications from open abdominal surgery. During the operation, the creation of pneumoperitoneum is used for better visualization of the operating field. However, the effect of pneumoperitoneum on kidney function is unknown. We aimed to identify risk factors and predictors associated with AKI development following laparoscopic abdominal surgery.

Methods: A single-center prospective cohort study of laparoscopic abdominal surgery patients between June 2012 and December 2013. Acute kidney injury (AKI) was identified by Kidney Disease Improving Global Outcome (KDIGO) criteria. Urinary neutrophil gelatinase associated lipocalin (uNGAL) was measured on the first 3 days after surgery as a surrogate marker of AKI.

Results: Of the 64 patients, 23 (35%) developed postoperative AKI. The mean age, initial blood pressure, and initial glomerular filtration rate were not different between AKI and non-AKI groups. Inflation time and exposure index were significantly higher in the AKI group compared to non-AKI group (192.0 vs 151.1 min, p = 0.045, and 2325.9 vs 1866.1 mmHg-minutes, p = 0.035). Operation time, mean intra-abdominal pressure, duration of intraoperative hypotension, amount of blood loss and intravenous fluid were not different between groups. In multivariable analysis adjusted for age, diabetes, baseline estimated glomerular filtration rate, and type of operation (urological surgery), exposure index was significantly associated with postoperative AKI, with odds ratio (95% CI) 1.47 (1.05-2.04), p = 0.024. By combining the intraoperative parameters with clinical model the area under the receiver operating characteristic curve was 0.71 (95% CI 0.58-0.84).

Conclusions: AKI was a common condition in laparoscopic abdominal surgery. Exposure index has been proposed as a novel predictor of laparoscopic abdominal surgery associated AKI.

Keywords: Acute kidney injury; Exposure index; Intra-abdominal hypertension; Laparoscopic abdominal surgery; NGAL.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by The Institutional Review Board (IRB No. 393/55), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. All participants accepted the protocol, and provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Subject disposition for the study

Fig. 2

Comparison of serum creatinine at different time points between AKI and non-AKI groups

Fig. 3

Comparison of uNGAL at different time points between AKI and non-AKI groups

Fig. 4

Urine output in 30 min-period during the operation time: AKI group (long dotted line) and non-AKI group (black solid line)

Fig. 5

The area under the curve (AUC) for predictive factors of AKI after laparoscopic abdominal surgery. a operation time alone, inflation time alone, exposure index alone, and baseline factors alone*. b operation time + baseline factors* (a), inflation time + baseline factors* (b), exposure + baseline factors* c). operation time + inflation time + exposure index + baseline factors*.* baseline factors including age, diabetic status, baseline eGFR, and type of operation (urological surgery).