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Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis

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Abstract

Purpose

This systematic review and meta-analysis aimed to evaluate the association between intraoperative oliguria and the risk of postoperative acute kidney injury (AKI) in patients undergoing non-cardiac surgery.

Methods

The MEDLINE and EMBASE databases were searched up to August 2022 for studies in adult patients undergoing non-cardiac surgery, where the association between intraoperative urine output and the risk of postoperative AKI was assessed. Both randomised and non-randomised studies were eligible for inclusion. Study selection and risk of bias assessment were independently performed by two investigators. The risk of bias was evaluated using the Newcastle–Ottawa scale. We performed meta-analysis of the reported multivariate adjusted odds ratios for the association between intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the risk of postoperative AKI using the inverse-variance method with random effects models. We conducted sensitivity analyses using varying definitions of oliguria as well as by pooling unadjusted odds ratios to establish the robustness of the primary meta-analysis. We also conducted subgroup analyses according to surgery type and definition of AKI to explore potential sources of clinical or methodological heterogeneity.

Results

Eleven studies (total 49,252 patients from 11 observational studies including a post hoc analysis of a randomised controlled trial) met the selection criteria. Seven of these studies contributed data from a total 17,148 patients to the primary meta-analysis. Intraoperative oliguria was associated with a significantly elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.36–2.23, p < 0.0001, 8 studies). Sensitivity analyses supported the robustness of the primary meta-analysis. There was no evidence of any significant subgroup differences according to surgery type or definition of AKI.

Conclusions

This study demonstrated a significant association between intraoperative oliguria and the risk of postoperative AKI, regardless of the definitions of oliguria or AKI used. Further prospective and multi-centre studies using standardised definitions of intraoperative oliguria are required to define the thresholds of oliguria and establish strategies to minimise the risk of AKI.

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Data availability

All datasets utilised in the analysis during the current study are available from the corresponding author on reasonable request.

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Funding

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Author information

Authors and Affiliations

  1. Department of Anaesthesia, Westmead Hospital, Westmead, Australia

    David A. Milder & Sophie S. Liang

  2. Department of Anaesthesiology, Sengkang General Hospital, Singapore, Singapore

    Sharon G. K. Ong

  3. Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore

    Sharon G. K. Ong

  4. Discipline of Anaesthesia, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia

    Peter C. A. Kam

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  1. David A. Milder
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  2. Sophie S. Liang
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  4. Peter C. A. Kam
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Contributions

DAM contributed to study conception, acquisition, analysis, interpretation of data, drafting, and editing of the manuscript. SSL contributed to analysis, interpretation of data, drafting and editing of the manuscript. SGKO contributed to acquisition, analysis, interpretation of data, drafting, and editing of the manuscript. PCAK provided oversight and expertise on all aspects of the manuscript including study conception, acquisition, analysis, interpretation of data, drafting, and editing of the manuscript.

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Correspondence to Peter C. A. Kam.

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Supplementary Information

Below is the link to the electronic supplementary material.

540_2022_3150_MOESM1_ESM.pptx

Supplementary file1 Sensitivity Analysis: Odds ratio of Acute Kidney Injury according to the presence of oliguria as defined by the study (PPTX 99 KB)

540_2022_3150_MOESM2_ESM.pptx

Supplementary file2 Sensitivity Analysis: Odds ratio of Acute Kidney Injury according to the presence of oliguria (<0.3 mL/kg/hr) (PPTX 90 KB)

540_2022_3150_MOESM3_ESM.pptx

Supplementary file3 Sensitivity Analysis: Odds ratio of Acute Kidney Injury according to the presence of oliguria (<0.5 mL/kg/hr) using pooled unadjusted data (PPTX 84 KB)

540_2022_3150_MOESM4_ESM.pptx

Supplementary file4 Subgroup Analysis according to surgery type, to identify any subgroup differences between patients undergoing nephrectomy (partial or total) and all other types of surgery: Odds ratio of Acute Kidney Injury according to according to the presence of oliguria (<0.5 mL/kg/hr) (PPTX 114 KB)

540_2022_3150_MOESM5_ESM.pptx

Supplementary file5 Subgroup Analysis according to surgery type: Odds ratio of Acute Kidney Injury according to the presence of oliguria (<0.5mL/kg/hr) (PPTX 128 KB)

540_2022_3150_MOESM6_ESM.pptx

Supplementary file6 Subgroup Analysis according to definition of Acute Kidney Injury: Odds ratio of AKI according to according to the presence of oliguria (<0.5 mL/kg/hr) (PPTX 123 KB)

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Milder, D.A., Liang, S.S., Ong, S.G.K. et al. Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis. J Anesth 37, 219–233 (2023). https://doi.org/10.1007/s00540-022-03150-8

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  • DOI: https://doi.org/10.1007/s00540-022-03150-8

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