Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Data
2.2. Definition of AKI
2.3. Statistics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Before PSM | After PSM | |||||
---|---|---|---|---|---|---|
Variables | TIVA (n = 766) | Volatile (n = 2998) | ASD | TIVA (n = 766) | Volatile (n = 766) | ASD |
Age (years) | 60.6 ± 13.5 | 64.1 ± 13.0 | 0.27 | 60.6 ± 13.5 | 61.5 ± 13.7 | 0.06 |
Male sex | 470 (61.4%) | 1457 (48.6%) | 0.26 | 470 (61.4%) | 468 (61.1%) | 0.05 |
BMI (kg m−2) | 27.9 ± 82.4 | 27.0 ± 25.2 | 0.01 | 27.9 ± 82.4 | 26.1 ± 14.4 | 0.02 |
ASA | 0.062 | |||||
1 | 219 (28.6%) | 811 (27.1%) | 219 (28.6%) | 218 (28.5%) | ||
2 | 464 (60.6%) | 1848 (61.6%) | 0.03 | 464 (60.6%) | 450 (58.7%) | |
3 + 4 | 83 (10.8%) | 339 (11.3%) | 0.04 | 83 (10.8%) | 98 (12.8%) | |
Comorbidities | ||||||
Hypertension | 335 (43.7%) | 1510 (50.4%) | 0.13 | 335 (43.7%) | 336 (43.9%) | 0.003 |
Diabetes mellitus | 18 (24.3%) | 723 (24.1%) | 0.003 | 186 (24.3%) | 211 (27.5%) | 0.075 |
Coronary disease | 70 (9.1%) | 304 (10.1%) | 0.03 | 70 (9.1%) | 80 (10.4%) | 0.044 |
Dyslipidemia | 52 (6.8%) | 197 (6.6%) | 0.01 | 52 (6.8%) | 58 (7.6%) | 0.03 |
Smoking | 358 (46.7%) | 1011 (33.7%) | 0.28 | 358 (46.7%) | 361 (47.1%) | 0.008 |
Anemia | 128 (16.7%) | 561 (18.7%) | 0.05 | 128 (16.7%) | 127 (16.6%) | 0.004 |
Medication | ||||||
NSAIDs | 113 (14.8%) | 451 (15%) | 0.01 | 113 (14.8%) | 121 (15.8%) | 0.029 |
ACEi/ARB | 177 (23.1%) | 670 (22.4%) | 0.02 | 177 (23.1%) | 202 (26.4%) | 0.076 |
Diuretics | 60 (7.8%) | 215 (7.2%) | 0.03 | 60 (7.8%) | 62 (8.1%) | 0.01 |
Surgical parameter | ||||||
Surgical level | 2.2 (1.3) | 1.6 (1.0) | 0.57 | 2.2 (1.3) | 1.7 (1.1) | 0.41 |
Surgical time (min) | 184.3 (97.6) | 160.7 (79.8) | 0.3 | 184.3 (97.6) | 185.5 (94.6) | 0.01 |
Anesthetic parameter | ||||||
Hypotension * | 154 (20.1%) | 938 (31.3%) | 0.24 | 154 (20.1%) | 149 (19.5%) | 0.016 |
Hypothermia † | 253 (33%) | 1140 (38%) | 0.1 | 253 (33%) | 254 (33.2%) | 0.002 |
Transfusion (mL) | 88.4 (451) | 46.9 (210) | 0.2 | 88.4 (451) | 88.8 (316) | <0.001 |
Crystalloid (mL) | 1498 (790.2) | 1167.7 (652.8) | 0.5 | 1498 (790.2) | 1498 (850) | <0.001 |
Colloid (mL) | 242.4 (394.8) | 248 (354.1) | 0.02 | 242.4 (394.8) | 271.2 (380.8) | 0.07 |
Blood loss (mL) | 339.7 (598.9) | 341 (422) | 0.003 | 339.7 (598.9) | 366.1 (468.7) | 0.05 |
Ephedrine | 628 (82%) | 2379 (79%) | 0.07 | 628 (82%) | 639 (83.4%) | 0.038 |
Phenylephrine | 470 (61.4%) | 1649 (55%) | 0.13 | 470 (61.4%) | 472 (61.6%) | 0.005 |
Norepinephrine | 94 (12.3%) | 272 (9.1%) | 0.11 | 94 (12.3%) | 94 (12.3%) | <0.001 |
TIVA (n = 766) | Volatile (n = 766) | p-Value | |
---|---|---|---|
Total AKI | 8 (1%) | 32 (4.2%) | <0.001 * |
AKI stage 1 | 7 (0.9%) | 32 (4.2%) | |
AKI stage 2 | 1 (0.1%) | 0 (0%) |
Variables | Univariate Model | Multivariate Model | ||
---|---|---|---|---|
Odd Ratio (95% CI) | p-Value | Odd Ratio (95% CI) | p-Value | |
Age over 70 years | 1.27 (0.88–1.81) | 0.2 | ||
Male sex (vs. female) | 1.57 (1.09–2.27) | 0.02 * | 1.85 (1.18–3.06) | <0.001 |
BMI | 0.99 (0.99–1.01) | 0.95 | ||
ASA physical status | ||||
1 | ||||
2 | 3.02 (1.68–5.44) | <0.001 * | ||
3 + 4 | 5.35 (2.73–10.47) | <0.001 * | ||
Comorbidities | ||||
Hypertension | 3.17 (2.11–4.75) | <0.001 * | 2.48 (1.56–3.94) | <0.001 |
Diabetes mellitus | 2.06 (1.43–2.96) | <0.001 * | ||
Coronary disease | 1.54 (0.92–2.56) | 0.1 | ||
Dyslipidemia | 0.83 (0.38–1.79) | 0.63 | ||
Smoking | 1.56 (1.1–2.23) | 0.01 * | ||
Anemia | 2.58 (1.78–3.76) | <0.001 * | 2.66 (1.76–4.04) | <0.001 |
Medication | ||||
NSAIDs | 0.82 (0.48–1.4) | 0.47 | ||
ACEi/ARB | 1.51 (1.02–2.23) | 0.04 * | ||
Diuretics | 1.9 (1.11–3.25) | 0.02 * | ||
Surgical parameter | ||||
Level count | 1.17 (1.01–1.35) | 0.04 * | ||
Surgical time >3 h | 1.5 (1.05–2.14) | 0.025 * | ||
Anesthetic parameter | ||||
Hypotension † | 1.58 (1.1–2.28) | 0.01 * | ||
Hypothermia ‡ | 1.09 (0.75–1.56) | 0.66 | ||
Transfusion | 1.00 (0.99–1.00) | 0.15 | ||
Crystalloid | 1.00 (0.99–1.00) | 0.12 | ||
Colloid | 1.00 (0.99–1.00) | 0.89 | ||
Estimated blood loss | 1.00 (0.99–1.00) | 0.35 | ||
Ephedrine | 1.02 (0.65–1.59) | 0.94 | ||
Phenylephrine | 0.94 (0.66–1.34) | 0.72 | ||
Norepinephrine | 1.37 (0.8–2.34) | 0.25 | ||
Anesthetic agent: volatile (vs. TIVA) | 3.88 (1.89–7.98) | <0.001 * | 4.69 (2.24–9.83) | <0.001 |
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Han, J.; Oh, A.-Y.; Koo, C.-H.; Bae, Y.K.; Jeon, Y.-T. Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study. J. Clin. Med. 2021, 10, 5653. https://doi.org/10.3390/jcm10235653
Han J, Oh A-Y, Koo C-H, Bae YK, Jeon Y-T. Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study. Journal of Clinical Medicine. 2021; 10(23):5653. https://doi.org/10.3390/jcm10235653
Chicago/Turabian StyleHan, Jiwon, Ah-Young Oh, Chang-Hoon Koo, Yu Kyung Bae, and Yong-Tae Jeon. 2021. "Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study" Journal of Clinical Medicine 10, no. 23: 5653. https://doi.org/10.3390/jcm10235653