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The effect of intra-operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery
Anaesthesia ( IF 10.7 ) Pub Date : 2021-09-23 , DOI: 10.1111/anae.15555
M T Kluger 1, 2 , J M K Collier 2 , R Borotkanics 3 , J M van Schalkwyk 4 , D A Rice 2, 5
Affiliation  

The association between intra-operative hypotension and postoperative acute kidney injury, mortality and length of stay has not been comprehensively evaluated in a large single-centre hip fracture population. We analysed electronic anaesthesia records of 1063 patients undergoing unilateral hip fracture surgery, collected from 2015 to 2018. Acute kidney injury, 3-, 30- and 365-day mortality and length of stay were evaluated to assess the relationship between intra-operative hypotension absolute values (≤ 55, 60, 65, 70 and 75 mmHg) and duration of hypotension. The rate of acute kidney injury was 23.7%, mortality at 3-, 30- and 365 days was 3.7%, 8.0% and 25.3%, respectively, and median (IQR [range]) length of stay 8 (6–12 [0–99]) days. Median (IQR [range]) time ≤ MAP 55, 60, 65, 70 and 75 mmHg was 0 (0–0.5[0–72.1]); 0 (0–4.4 [0–104.9]); 2.2 (0–8.7 [0–144.2]); 6.6 (2.2–19.7 [0–198.8]); 17.5 (6.6–37.1 [0–216.3]) minutes, and percentage of surgery time below these thresholds was 1%, 2.5%, 7.9%, 12% and 21% respectively. There were some univariate associations between hypotension and mortality; however, these were no longer evident in multivariable analysis. Multivariable analysis found no association between hypotension and acute kidney injury. Acute kidney injury was associated with male sex, antihypertensive medications and cardiac/renal comorbidities. Three-day mortality was associated with delay to surgery ? 48 hours, whilst 30-day and 365-day mortality was associated with delay to surgery ≥ 48 hours, impaired cognition and cardiac/renal comorbidities. While the rate of acute kidney injury was similar to other studies, use of vasopressors and fluids to reduce the time spent at hypotensive levels failed to reduce this complication. Intra-operative hypotension at the levels observed in this cohort may not be an important determinant of acute kidney injury, postoperative mortality and length of stay.

中文翻译:

术中低血压对急诊髋部骨折手术后急性肾损伤、术后死亡率和住院时间的影响

尚未在大型单中心髋部骨折人群中全面评估术中低血压与术后急性肾损伤、死亡率和住院时间之间的关系。我们分析了 2015 年至 2018 年收集的 1063 例单侧髋部骨折手术患者的电子麻醉记录。评估了急性肾损伤、3 天、30 天和 365 天死亡率和住院时间,以评估术中低血压绝对值之间的关系。值(≤ 55、60、65、70 和 75 mmHg)和低血压持续时间。急性肾损伤率为 23.7%,3 天、30 天和 365 天的死亡率分别为 3.7%、8.0% 和 25.3%,中位(IQR [范围])住院时间为 8(6-12 [0 –99]) 天。中位数(IQR [范围])时间 ≤ MAP 55、60、65、70 和 75 mmHg 为 0 (0–0.5[0–72.1]);0 (0–4.4 [0–104.9]); 2.2(0-8。7 [0-144.2]);6.6 (2.2–19.7 [0–198.8]); 17.5 (6.6–37.1 [0–216.3]) 分钟,低于这些阈值的手术时间百分比分别为 1%、2.5%、7.9%、12% 和 21%。低血压和死亡率之间存在一些单变量关联;然而,这些在多变量分析中不再明显。多变量分析发现低血压和急性肾损伤之间没有关联。急性肾损伤与男性、抗高血压药物和心脏/肾脏合并症有关。三天死亡率与手术延迟有关 ? 48 小时,而 30 天和 365 天死亡率与手术延迟≥ 48 小时、认知障碍和心脏/肾脏合并症有关。虽然急性肾损伤的发生率与其他研究相似,使用血管加压药和液体来减少在低血压水平上花费的时间未能减少这种并发症。在该队列中观察到的术中低血压可能不是急性肾损伤、术后死亡率和住院时间的重要决定因素。
更新日期:2021-09-23
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