Intraoperative Hypotension Is Not Correlated With Acute Kidney Injury During Spinal Fusion Surgery

Area of Science:

• Neurosurgery
• Anesthesiology
• Nephrology

Background:

• Intraoperative hypotension (IOH) is linked to organ damage, including acute kidney injury (AKI).
• The association between IOH and AKI in spinal fusion patients remains understudied.
• This study investigates the relationship between IOH and postoperative AKI in spinal fusion surgery.

Purpose of the Study:

• To determine the association between intraoperative hypotension (IOH) and postoperative acute kidney injury (AKI) in patients undergoing spinal fusion.
• To explore the relationship between IOH metrics and other postoperative outcomes such as ileus and troponin leak.

Main Methods:

• Retrospective cohort study of 910 patients undergoing posterior spinal fusion.
• Intraoperative data included minute-by-minute mean arterial pressure (MAP), fluid administration, and urine output.
• IOH defined as MAP <65 mm Hg for >10 minutes; AKI assessed using KDIGO criteria.

Main Results:

• No significant association was found between IOH metrics and postoperative AKI.
• IOH was not associated with postoperative ileus, troponin leak, or length of stay.
• Findings contrast with existing literature, suggesting potential differences in patient populations or a more complex relationship.

Conclusions:

• Occurrence and duration of IOH were not associated with AKI or other major adverse outcomes in spinal fusion patients.
• This study provides level 3 evidence that challenges the established link between IOH and AKI in this specific surgical context.
• Further research is warranted to elucidate the precise nature of the IOH-AKI relationship in spinal surgery.