Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis
Background: Laparoscopic surgical approaches enhance recovery, reduce postoperative pain, and shorten hospital length-of-stay. Nevertheless, increased intra-abdominal pressure is associated with decreased renal blood flow, renal hypoxia and acute kidney injury. When combined with Trendelenburg posit...
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doaj-e931777ad8544f399d6eb95db78796542021-03-11T04:22:40ZengElsevierBrazilian Journal of Anesthesiology0104-00142021-01-017115057Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysisHani Essber0Barak Cohen1Amanda S. Artis2Steve M. Leung3Kamal Maheshwari4Mohammad Zafeer Khan5Daniel I. Sessler6Alparslan Turan7Kurt Ruetzler8Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OH; Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv Medical Center, Division of Anesthesia, Intensive Care, and Pain Management, IsraelCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OH; Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OH; Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesia, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OH; Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesia, Cleveland, OHCleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, OH; Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesia, Cleveland, OH; Corresponding author.Background: Laparoscopic surgical approaches enhance recovery, reduce postoperative pain, and shorten hospital length-of-stay. Nevertheless, increased intra-abdominal pressure is associated with decreased renal blood flow, renal hypoxia and acute kidney injury. When combined with Trendelenburg positioning, renal function may further deteriorate. We tested the primary hypothesis that the combination of laparoscopic surgical approach and Trendelenburg position is associated with larger reductions in estimated Glomerular Filtration Rate (eGFR) within the initial 48 postoperative hours compared to open surgery without Trendelenburg positioning. Secondarily, we tested, if laparoscopic procedures are associated with greater incidence of postoperative acute kidney injury. Methods: Adults who had laparoscopic colorectal surgery in Trendelenburg position at the Cleveland Clinic Main Campus from 2009 to 2016 were propensity-matched to patients who had comparable open procedures. Patients with pre-existing renal impairment were excluded. Results: Among 7,357 eligible patients, 1,846 laparoscopic cases with Trendelenburg were matched to 1,846 open cases. No association was found between laparoscopic approach and postoperative eGFR. A significant protective effect of the laparoscopic procedure on the odds of having AKI was found. Patients who had laparoscopic surgeries were an estimated 0.70 (95% CI 0.55, 0.90, pHolm-adj = 0.006) times as likely to have AKI as open surgical patients. Conclusion: Despite compelling potential mechanisms, laparoscopic approach with Trendelenburg position in adult colorectal surgeries did not worsen postoperative eGFR, and actually reduced postoperative acute kidney injury. Given the other advantages of laparoscopic surgery, the approach should not be avoided for concerns about renal injury.http://www.sciencedirect.com/science/article/pii/S0104001420302104Acute kidney injuryLaparoscopyAnesthesia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hani Essber Barak Cohen Amanda S. Artis Steve M. Leung Kamal Maheshwari Mohammad Zafeer Khan Daniel I. Sessler Alparslan Turan Kurt Ruetzler |
spellingShingle |
Hani Essber Barak Cohen Amanda S. Artis Steve M. Leung Kamal Maheshwari Mohammad Zafeer Khan Daniel I. Sessler Alparslan Turan Kurt Ruetzler Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis Brazilian Journal of Anesthesiology Acute kidney injury Laparoscopy Anesthesia |
author_facet |
Hani Essber Barak Cohen Amanda S. Artis Steve M. Leung Kamal Maheshwari Mohammad Zafeer Khan Daniel I. Sessler Alparslan Turan Kurt Ruetzler |
author_sort |
Hani Essber |
title |
Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
title_short |
Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
title_full |
Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
title_fullStr |
Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
title_full_unstemmed |
Renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
title_sort |
renal injury after open versus laparoscopic non-cardiac surgery: a retrospective cohort analysis |
publisher |
Elsevier |
series |
Brazilian Journal of Anesthesiology |
issn |
0104-0014 |
publishDate |
2021-01-01 |
description |
Background: Laparoscopic surgical approaches enhance recovery, reduce postoperative pain, and shorten hospital length-of-stay. Nevertheless, increased intra-abdominal pressure is associated with decreased renal blood flow, renal hypoxia and acute kidney injury. When combined with Trendelenburg positioning, renal function may further deteriorate. We tested the primary hypothesis that the combination of laparoscopic surgical approach and Trendelenburg position is associated with larger reductions in estimated Glomerular Filtration Rate (eGFR) within the initial 48 postoperative hours compared to open surgery without Trendelenburg positioning. Secondarily, we tested, if laparoscopic procedures are associated with greater incidence of postoperative acute kidney injury. Methods: Adults who had laparoscopic colorectal surgery in Trendelenburg position at the Cleveland Clinic Main Campus from 2009 to 2016 were propensity-matched to patients who had comparable open procedures. Patients with pre-existing renal impairment were excluded. Results: Among 7,357 eligible patients, 1,846 laparoscopic cases with Trendelenburg were matched to 1,846 open cases. No association was found between laparoscopic approach and postoperative eGFR. A significant protective effect of the laparoscopic procedure on the odds of having AKI was found. Patients who had laparoscopic surgeries were an estimated 0.70 (95% CI 0.55, 0.90, pHolm-adj = 0.006) times as likely to have AKI as open surgical patients. Conclusion: Despite compelling potential mechanisms, laparoscopic approach with Trendelenburg position in adult colorectal surgeries did not worsen postoperative eGFR, and actually reduced postoperative acute kidney injury. Given the other advantages of laparoscopic surgery, the approach should not be avoided for concerns about renal injury. |
topic |
Acute kidney injury Laparoscopy Anesthesia |
url |
http://www.sciencedirect.com/science/article/pii/S0104001420302104 |
work_keys_str_mv |
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