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Abstract
Intraoperative hemodynamics can affect postoperative kidney function. We aimed to investigate the effect of intraoperative mean arterial pressure (MAP) as well as other risk factors on the occurrence of acute kidney injury (AKI) after robot-assisted laparoscopic prostatectomy (RALP). We retrospectively evaluated the medical records of 750 patients who underwent RALP. The average real variability (ARV)-MAP, standard deviation (SD)-MAP, time-weighted average (TWA)-MAP, area under threshold (AUT)-65 mmHg, and area above threshold (AAT)-120 mmHg were calculated using MAPs collected within a 10-s interval. Eighteen (2.4%) patients developed postoperative AKI. There were some univariable associations between TWA-MAP, AUT-65 mmHg, and AKI occurrence; however, multivariable analysis found no association. Alternatively, American Society of Anesthesiologists physical status ≥ III and the low intraoperative urine output were independently associated with AKI occurrence. Moreover, none of the five MAP parameters could predict postoperative AKI, with the area under the receiver operating characteristic curve values for ARV-MAP, SD-MAP, TWA-MAP, AUT-65 mmHg, and AAT-120 mmHg being 0.561 (95% confidence interval [CI], 0.424–0.697), 0.561 (95% CI, 0.417–0.704), 0.584 (95% CI, 0.458–0.709), 0.590 (95% CI, 0.462–0.718), and 0.626 (95% CI, 0.499–0.753), respectively. Therefore, intraoperative MAP changes may not be a determining factor for AKI after RALP.
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1 Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea (GRID:grid.15444.30) (ISNI:0000 0004 0470 5454)
2 Yonsei University College of Medicine, Biostatistics Collaboration Unit, Seoul, Republic of Korea (GRID:grid.15444.30) (ISNI:0000 0004 0470 5454)