Skip to main content

Advertisement

SpringerLink
Log in

A goal-directed therapy protocol for preventing acute kidney injury after laparoscopic liver resection: a retrospective observational cohort study

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Postoperative acute kidney injury (AKI) remains a serious complication of liver resection with restrictive fluid therapy. However, unlike open hepatectomy, laparoscopic liver resection (LLR) does not have established anesthesia management strategies. We compared our goal-directed therapy (GDT) protocol for LLR with/without carperitide and the conventional restrictive method regarding AKI prevention.

Methods

The GDT thresholds in this retrospective observational cohort study were as follows: stroke volume variation, ≤ 15%; pulse pressure variation, ≤ 13%; oxygen delivery index, ≥ 600 mL/min/m2; and mean arterial pressure (MAP), ≥ 55 mmHg. If the thresholds were not achieved, a 250 mL infusion fluid bolus was administered. The MAP target was changed to > 65 mmHg if the urine output was < 0.3 mL/kg/h. Postoperative AKI within 48 h and perioperative outcomes within 90 days were analyzed.

Results

Forty-seven propensity score-matched pairs from 127 patients were investigated. We adjusted for AKI risk factors and surgical difficulty; 46.8% of the GDT group received carperitide. The GDT group had a lower postoperative AKI rate (10.6% vs. 27.7%, P = 0.04) and shorter overall (P = 0.04) and postoperative (P < 0.01) hospital stays than the conventional group. Furthermore, the GDT group received more intraoperative fluid (P = 0.001) and phenylephrine (P = 0.02), without significant increases in blood loss and transfusion volume, than the conventional group.

Conclusions

GDT reduced the AKI rates post-LLR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The raw data used in this study are available from the corresponding author upon reasonable request.

References

  1. Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249:617–23.

    Article  Google Scholar 

  2. Tranchart H, O’Rourke N, Van Dam R, Gaillard M, Lainas P, Sugioka A, et al. Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci. 2015;22:371–8.

    Article  Google Scholar 

  3. Bressan AK, James MT, Dixon E, Bathe OF, Sutherland FR, Ball CG. Acute kidney injury following resection of hepatocellular carcinoma: prognostic value of the acute kidney injury network criteria. Can J Surg. 2018;61:E11–6.

    Article  Google Scholar 

  4. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–70.

    Article  Google Scholar 

  5. Ratti F, Cipriani F, Reineke R, Catena M, Paganelli M, Comotti L, et al. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial. HPB (Oxford). 2016;18:136–44.

    Article  Google Scholar 

  6. Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, et al. A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal approach. Ann Surg. 2015;261:1226–31.

    Article  Google Scholar 

  7. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study Crit Care Med. 2009;37:2079–90.

    Article  Google Scholar 

  8. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.

    Article  Google Scholar 

  9. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–23.

    Article  Google Scholar 

  10. Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126:47–65.

    Article  Google Scholar 

  11. Giglio M, Dalfino L, Puntillo F, Brienza N. Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis. Crit Care. 2019;23:232.

    Article  Google Scholar 

  12. Mizuguchi T, Kawamoto M, Meguro M, Hui TT, Hirata K. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014;44:1–10.

    Article  Google Scholar 

  13. Wakabayashi G. What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr. 2016;5:281–9.

    Article  Google Scholar 

  14. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–84.

    Article  Google Scholar 

  15. Kheterpal S, Tremper KK, Heung M, Rosenberg AL, Englesbe M, Shanks AM, 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;110:505–15.

    Article  Google Scholar 

  16. Kheterpal S, Tremper KK, Englesbe MJ, O’Reilly M, Shanks AM, Fetterman DM, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology. 2007;107:892–902.

    Article  Google Scholar 

  17. Ricksten SE, Bragadottir G, Redfors B. Renal oxygenation in clinical acute kidney injury. Crit Care. 2013;17:221.

    Article  Google Scholar 

  18. Kunst G, Ostermann M. Intraoperative permissive oliguria - how much is too much? Br J Anaesth. 2017;119:1075–7.

    Article  CAS  Google Scholar 

  19. Turan A, Cohen B, Adegboye J, Makarova N, Liu L, Mascha EJ, et al. Mild acute kidney injury after noncardiac surgery is associated with long-term renal dysfunction: a retrospective cohort study. Anesthesiology. 2020;132:1053–61.

    Article  Google Scholar 

  20. Guest JF, Boyd O, Hart WM, Grounds RM, Bennett ED. A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients. Intensive Care Med. 1997;23:85–90.

    Article  CAS  Google Scholar 

  21. Fenwick E, Wilson J, Sculpher M, Claxton K. Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis. Intensive Care Med. 2002;28:599–608.

    Article  Google Scholar 

  22. Chong MA, Wang Y, Berbenetz NM, McConachie I. Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: A systematic review and meta-analysis. Eur J Anaesthesiol. 2018;35:469–83.

    Article  Google Scholar 

  23. Saner F. Kidney failure following liver resection. Transplant Proc. 2008;40:1221–4.

    Article  CAS  Google Scholar 

  24. Sear JW. Kidney dysfunction in the postoperative period. Br J Anaesth. 2005;95:20–32.

    Article  CAS  Google Scholar 

  25. Saito K, Uchino S, Fujii T, Saito S, Takinami M, Uezono S. Effect of low-dose atrial natriuretic peptide in critically ill patients with acute kidney injury: a retrospective, single-center study with propensity-score matching. BMC Nephrol. 2020;21:31.

    Article  CAS  Google Scholar 

  26. Yamada H, Doi K, Tsukamoto T, Kiyomoto H, Yamashita K, Yanagita M, et al. Low-dose atrial natriuretic peptide for prevention or treatment of acute kidney injury: a systematic review and meta-analysis. Crit Care. 2019;23:41.

    Article  Google Scholar 

  27. Yamada T, Kotake Y, Nagata H, Takeda J. Atrial natriuretic peptide reduces hepatic ischemia-reperfusion injury in rabbits. J Anesth. 2013;27:901–8.

    Article  Google Scholar 

  28. Gregory A, Stapelfeldt WH, Khanna AK, Smischney NJ, Boero IJ, Chen Q, et al. Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. Anesth Analg. 2021;132:1654–65.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Mr. Kenta Sato for providing invaluable help with the statistical analyses.

Funding

This study was not funded by any external sources.

Author information

Authors and Affiliations

  1. Division of Anesthesia, Mitsui Memorial Hospital, Kanda-Izumi-cho-1, Chiyoda-ku, Tokyo, 101-8643, Japan

    Eriya Imai

  2. Department of Pharmacology, Ageo Central General Hospital, Saitama, Japan

    Yoshihito Morohashi

  3. Department of Surgery, Ageo Central General Hospital, Saitama, Japan

    Kohei Mishima, Takahiro Ozaki, Kazuharu Igarashi & Go Wakabayashi

Authors
  1. Eriya Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihito Morohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kohei Mishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takahiro Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuharu Igarashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eriya Imai.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Imai, E., Morohashi, Y., Mishima, K. et al. A goal-directed therapy protocol for preventing acute kidney injury after laparoscopic liver resection: a retrospective observational cohort study. Surg Today 52, 1262–1274 (2022). https://doi.org/10.1007/s00595-022-02453-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02453-3

Keywords

Search

Navigation