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Urine output and acute kidney injury following laparoscopic pancreas operations

      Abstract

      Background

      This study aims to assess if intraoperative urine output is associated with acute kidney injury (AKI) during laparoscopic pancreas surgery.

      Methods

      Medical records of adult patients who underwent laparoscopic pancreas surgery from 2010 to 2020 were reviewed to identify patients who experienced AKI (creatinine increase of 0.3 mg/dL within 72 h). Surgeries were classified as with ‘vascular reconstruction’ (e.g. Whipple, total pancreatectomy) versus ‘without reconstruction’ (e.g., distal pancreatectomy).

      Results

      Included were 365 patients (221 with and 114 without reconstruction), and 42 (11.4%) developed AKI (32 [14.5%] reconstruction and 10 [6.9%] without reconstruction (P = 0.164)). The median urine output for AKI group was 0.79 [0.43, 1.15] mL/kg/h and 0.88 [0.55, 1.53] mL/kg/h for non-AKI group, P = 0.121. Urine output between AKI and non-AKI did not vary among reconstruction cases (P = 0.383), but was lower in AKI patients without reconstruction (P = 0.047). Older age, preexisting kidney disease, higher disease burden, and intraoperative hypotension were associated with AKI. Postoperative course was more complicated for AKI patients including rates of pancreatic fistulas and mortality.

      Conclusion

      Incidence of AKI increases with more extensive surgery, but is not associated with low urine output. However, low urine output was associated with AKI in patients undergoing operation without reconstruction.
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      References

        • Gameiro J.
        • Fonseca J.A.
        • Neves M.
        • Jorge S.
        • Lopes J.A.
        Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes.
        Ann Intensive Care. 2018; 8: 22
        • Teixeira C.
        • Rosa R.
        • Rodrigues N.
        • Mendes I.
        • Peixoto L.
        • Dias S.
        • et al.
        Acute kidney injury after major abdominal surgery: a retrospective cohort analysis.
        Critical care research and practice. 2014; 2014132175
        • Joo E.Y.
        • Moon Y.J.
        • Yoon S.H.
        • Chin J.H.
        • Hwang J.H.
        • Kim Y.K.
        Comparison of acute kidney injury after robot-assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a propensity score matching analysis.
        Medicine. 2016; 95e2650
        • Moon Y.J.
        • Jun I.G.
        • Kim K.H.
        • Kim S.O.
        • Song J.G.
        • Hwang G.S.
        Comparison of acute kidney injury between open and laparoscopic liver resection: propensity score analysis.
        PLoS One. 2017; 12e0186336
        • Iwanaka T.
        • Arkovitz M.S.
        • Arya G.
        • Ziegler M.M.
        Evaluation of operative stress and peritoneal macrophage function in minimally invasive operations.
        J Am Coll Surg. 1997; 184: 357-363
        • Kendrick M.L.
        • Cusati D.
        Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience.
        Arch Surg. 2010; 145: 19-23
        • Vijan S.S.
        • Ahmed K.A.
        • Harmsen W.S.
        • Que F.G.
        • Reid-Lombardo K.M.
        • Nagorney D.M.
        • et al.
        Laparoscopic vs open distal pancreatectomy: a single-institution comparative study.
        Arch Surg. 2010; 145: 616-621
        • Lassen K.
        • Coolsen M.M.
        • Slim K.
        • Carli F.
        • de Aguilar-Nascimento J.E.
        • Schafer M.
        • et al.
        Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations.
        Clin Nutr. 2012; 31: 817-830
        • Lopes J.A.
        • Jorge S.
        The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review.
        Clinical kidney journal. 2013; 6: 8-14
        • Thomas M.E.
        • Blaine C.
        • Dawnay A.
        • Devonald M.A.
        • Ftouh S.
        • Laing C.
        • et al.
        The definition of acute kidney injury and its use in practice.
        Kidney Int. 2015; 87: 62-73
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Klein S.J.
        • Lehner G.F.
        • Forni L.G.
        • Joannidis M.
        Oliguria in critically ill patients: a narrative review.
        J Nephrol. 2018; 31: 855-862
        • Park Y.S.
        • Jun I.G.
        • Go Y.
        • Song J.G.
        • Hwang G.S.
        Comparison of acute kidney injury between open and laparoscopic pylorus-preserving pancreaticoduodenectomy: propensity score analysis.
        PLoS One. 2018; 13e0202980
        • Goren O.
        • Levy A.
        • Cattan A.
        • Lahat G.
        • Matot I.
        Acute kidney injury in pancreatic surgery; association with urine output and intraoperative fluid administration.
        Am J Surg. 2017; 214: 246-250
        • Karkouti K.
        • Beattie W.S.
        • Wijeysundera D.N.
        • Rao V.
        • Chan C.
        • Dattilo K.M.
        • et al.
        Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery.
        J Thorac Cardiovasc Surg. 2005; 129: 391-400
        • Srisawat N.
        • Kongwibulwut M.
        • Laoveeravat P.
        • Lumplergul N.
        • Chatkaew P.
        • Saeyub P.
        • et al.
        The role of intraoperative parameters on predicting laparoscopic abdominal surgery associated acute kidney injury.
        BMC Nephrol. 2018; 19: 289
        • Kheterpal S.
        • Tremper K.K.
        • Englesbe M.J.
        • O’Reilly M.
        • Shanks A.M.
        • Fetterman D.M.
        • et al.
        Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function.
        Anesthesiology. 2007; 107: 892-902
        • Nishio S.
        • Takeda H.
        • Yokoyama M.
        Changes in urinary output during laparoscopic adrenalectomy.
        BJU Int. 1999; 83: 944-947
        • Nguyen N.T.
        • Perez R.V.
        • Fleming N.
        • Rivers R.
        • Wolfe B.M.
        Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass.
        J Am Coll Surg. 2002; 195: 476-483
        • Shiba A.
        • Uchino S.
        • Fujii T.
        • Takinami M.
        • Uezono S.
        Association between intraoperative oliguria and acute kidney injury after major noncardiac surgery.
        Anesth Analg. 2018; 127: 1229-1235
        • Sodha S.
        • Nazarian S.
        • Adshead J.M.
        • Vasdev N.
        • Mohan S.G.
        Effect of pneumoperitoneum on renal function and physiology in patients undergoing robotic renal surgery.
        Curr Urol. 2016; 9: 1-4
        • Kirsch A.J.
        • Hensle T.W.
        • Chang D.T.
        • Kayton M.L.
        • Olsson C.A.
        • Sawczuk I.S.
        Renal effects of CO2 insufflation: oliguria and acute renal dysfunction in a rat pneumoperitoneum model.
        Urology. 1994; 43: 453-459
        • Wesselink E.M.
        • Kappen T.H.
        • Torn H.M.
        • Slooter A.J.C.
        • van Klei W.A.
        Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review.
        Br J Anaesth. 2018; 121: 706-721
        • Park S.
        • Cho H.
        • Park S.
        • Lee S.
        • Kim K.
        • Yoon H.J.
        • et al.
        Simple postoperative AKI risk (SPARK) classification before noncardiac surgery: a prediction index development study with external validation.
        J Am Soc Nephrol. 2019; 30: 170-181
        • Garnier J.
        • Faucher M.
        • Marchese U.
        • Meillat H.
        • Mokart D.
        • Ewald J.
        • et al.
        Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes.
        HPB. 2018; 20: 865-871
        • Joliat G.R.
        • Labgaa I.
        • Demartines N.
        • Halkic N.
        Acute kidney injury after liver surgery: does postoperative urine output correlate with postoperative serum creatinine?.
        HPB. 2020; 22: 144-150
        • Lim C.
        • Audureau E.
        • Salloum C.
        • Levesque E.
        • Lahat E.
        • Merle J.C.
        • et al.
        Acute kidney injury following hepatectomy for hepatocellular carcinoma: incidence, risk factors and prognostic value.
        HPB. 2016; 18: 540-548
        • Kheterpal S.
        • Tremper Kevin K.
        • Heung M.
        • Rosenberg A.L.
        • Englesbe M.
        • Shanks A.M.
        • et al.
        Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set.
        Anesthesiology. 2009; 110: 505-515
        • Singri N.
        • Ahya S.N.
        • Levin M.L.
        Acute renal failure.
        JAMA. 2003; 289: 747-751
        • Joosten A.
        • Ickx B.
        • Mokthari Z.
        • Van Obbergh L.
        • Lucidi V.
        • Collange V.
        • et al.
        Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury.
        BMC Anesthesiol. 2021; 21: 135
        • Turan A.
        • Cohen B.
        • Adegboye J.
        • Makarova N.
        • Liu L.
        • Mascha E.J.
        • et al.
        Mild acute kidney injury after noncardiac surgery is associated with long-term renal dysfunction: a retrospective cohort study.
        Anesthesiology. 2020; 132: 1053-1061
      1. Clinical practice Guidelines for acute kidney injury. 2012