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Association of the perfusion index with postoperative acute kidney injury: a retrospective study
Pyoyoon Kang1, Jung-Bin Park1, Hyun-Kyu Yoon1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Background:
Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI) that has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence.
Methods:
We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre- and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB. Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI.
Results:
Overall, 2,554 patients were identified and 1,586 patients were included in our analysis. According to Kidney Disease Improving Global Outcomes (KDIGO) criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio: 2.00, 95% CI [1.16, 3.44], P = 0.012) when PPI was less than 0.5 for more than 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists physical status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation.
Conclusions:
Low intraoperative PPI was independently associated with postoperative AKI.
Insights
Low intraoperative peripheral perfusion index (PPI) is linked to acute kidney injury (AKI) after surgery. Monitoring PPI may help prevent postoperative AKI.
Area of Science:
- Anesthesiology
- Nephrology
- Surgical Outcomes
Background:
- Postoperative acute kidney injury (AKI) is a significant concern.
- Intraoperative factors influencing AKI are not fully understood.
- Peripheral perfusion index (PPI) is a potential indicator of intraoperative perfusion.
Purpose of the Study:
- To investigate the association between intraoperative peripheral perfusion index (PPI) and postoperative acute kidney injury (AKI).
- To test the hypothesis that lower intraoperative PPI correlates with increased AKI risk.
Main Methods:
- Retrospective analysis of electronic medical records for 1,586 general surgery patients (May-November 2021).
- Intraoperative PPI was the primary exposure variable.
- Postoperative AKI, defined by KDIGO criteria, was the primary outcome.
Main Results:
- Postoperative AKI occurred in 7.8% of patients.
- Lower intraoperative PPI (<0.5 for >10% of surgery time) significantly increased AKI risk (OR 2.00, P=0.012).
- Other AKI risk factors included male sex, older age, higher ASA status, obesity, renal disease, longer operations, transfusion, and emergent surgery.
Conclusions:
- Intraoperative peripheral perfusion index (PPI) is an independent predictor of postoperative acute kidney injury (AKI).
- Monitoring and maintaining adequate intraoperative PPI may be crucial for preventing AKI.
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