Skip to main content

Advertisement

SpringerLink
Log in

The impact of total intravenous anesthesia versus inhalation anesthesia on acute kidney injury after major abdominal surgery: a propensity score analysis

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

The effect of anesthetic types on postoperative acute kidney injury (AKI) remains unclear particularly in patients undergoing non-cardiac surgery. The purpose of this retrospective study was to compare total intravenous anesthesia (TIVA) and inhalation anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS).

Methods

Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from 2016 to 2018 were included. Using the multivariable logistic regression, the risk of postoperative AKI was compared among patients who underwent TIVA (TIVA group) and inhalation anesthesia (inhalation group) both in the total cohort and in the propensity score-matched cohort. Additional multivariable logistic regression analysis was performed with inverse probability of treatment weighting (IPTW) using the propensity score.

Results

In total, 3616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the TIVA and inhalation groups, respectively. The risk of AKI was significantly higher in the inhalation group [adjusted odds ratio (aOR) 1.72; 95% confidence interval (CI) 1.27–2.35; P = 0.002] than the TIVA group. In the matched cohort (n = 1518 in each group), the inhalation group also had a higher risk of AKI (aOR 1.66; 95% CI 1.20–2.31; P = 0.002). The multivariable logistic regression with IPTW showed similar results (aOR 1.59; 95% CI 1.30–1.95; P < 0.001).

Conclusions

The risk of AKI after open MAS differed significantly according to the anesthetic used. Patients receiving inhalation anesthesia may have a greater risk of postoperative AKI than those undergoing TIVA.

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

References

  1. Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, Hunn BH. AKI and long-term risk for cardiovascular events and mortality. J Am Soc Nephrol. 2017;28:377–87.

    Article  Google Scholar 

  2. Teixeira C, Rosa R, Rodrigues N, Mendes I, Peixoto L, Dias S, Melo MJ, Pereira M, Bicha Castelo H, Lopes JA. Acute kidney injury after major abdominal surgery: a retrospective cohort analysis. Crit Care Res Pract. 2014;2014:132175.

    PubMed  PubMed Central  Google Scholar 

  3. Tomozawa A, Ishikawa S, Shiota N, Cholvisudhi P, Makita K. Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study. Can J Anaesth. 2015;62:753–61.

    Article  Google Scholar 

  4. Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, Layon AJ, Segal MS. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009;249:851–8.

    Article  Google Scholar 

  5. Gameiro J, Fonseca JA, Neves M, Jorge S, Lopes JA. Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes. Ann Intensive Care. 2018;8:22.

    Article  Google Scholar 

  6. Kim CS, Oak CY, Kim HY, Kang YU, Choi JS, Bae EH, Ma SK, Kweon SS, Kim SW. Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer. PLoS ONE. 2013;8:e82289.

    Article  Google Scholar 

  7. Kashy BK, Podolyak A, Makarova N, Dalton JE, Sessler DI, Kurz A. Effect of hydroxyethyl starch on postoperative kidney function in patients having noncardiac surgery. Anesthesiology. 2014;121:730–9.

    Article  CAS  Google Scholar 

  8. O’Connor ME, Kirwan CJ, Pearse RM, Prowle JR. Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med. 2016;42:521–30.

    Article  CAS  Google Scholar 

  9. Billings FT 4th, Ball SK, Roberts LJ 2nd, Pretorius M. Postoperative acute kidney injury is associated with hemoglobinemia and an enhanced oxidative stress response. Free Radic Biol Med. 2011;50:1480–7.

    Article  CAS  Google Scholar 

  10. Billings FT 4th, Pretorius M, Schildcrout JS, Mercaldo ND, Byrne JG, Ikizler TA, Brown NJ. Obesity and oxidative stress predict AKI after cardiac surgery. J Am Soc Nephrol. 2012;23:1221–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Runzer TD, Ansley DM, Godin DV, Chambers GK. Tissue antioxidant capacity during anesthesia: propofol enhances in vivo red cell and tissue antioxidant capacity in a rat model. Anesth Analg. 2002;94:89–93.

    CAS  PubMed  Google Scholar 

  12. Motayagheni N, Phan S, Eshraghi C, Nozari A, Atala A. A review of anesthetic effects on renal function: potential organ protection. Am J Nephrol. 2017;46:380–9.

    Article  CAS  Google Scholar 

  13. Lee HT, Chen SW, Doetschman TC, Deng C, D’Agati VD, Kim M. Sevoflurane protects against renal ischemia and reperfusion injury in mice via the transforming growth factor-beta1 pathway. Am J Physiol Renal Physiol. 2008;295:F128–36.

    Article  CAS  Google Scholar 

  14. Kong HY, Zhu SM, Wang LQ, He Y, Xie HY, Zheng SS. Sevoflurane protects against acute kidney injury in a small-size liver transplantation model. Am J Nephrol. 2010;32:347–55.

    Article  CAS  Google Scholar 

  15. Bang JY, Lee J, Oh J, Song JG, Hwang GS. The influence of propofol and sevoflurane on acute kidney injury after colorectal surgery: a retrospective cohort study. Anesth Analg. 2016;123:363–70.

    Article  CAS  Google Scholar 

  16. Yoo YC, Shim JK, Song Y, Yang SY, Kwak YL. Anesthetics influence the incidence of acute kidney injury following valvular heart surgery. Kidney Int. 2014;86:414–22.

    Article  CAS  Google Scholar 

  17. Li H, Weng Y, Yuan S, Liu W, Yu H, Yu W. Effect of sevoflurane and propofol on acute kidney injury in pediatric living donor liver transplantation. Ann Transl Med. 2019;7:340.

    Article  CAS  Google Scholar 

  18. Oh TK, Kim J, Han S, Kim K, Jheon S, Ji E. Effect of sevoflurane-based or propofol-based anaesthesia on the incidence of postoperative acute kidney injury: a retrospective propensity score-matched analysis. Eur J Anaesthesiol. 2019;36:649–55.

    Article  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  20. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.

    Article  Google Scholar 

  21. Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, Anstrom KJ. Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care. 2007;45:S103–7.

    Article  Google Scholar 

  22. Halpern EF. Behind the numbers: inverse probability weighting. Radiology. 2014;271:625–8.

    Article  Google Scholar 

  23. Schulte PJ, Mascha EJ. Propensity score methods: theory and practice for anesthesia research. Anesth Analg. 2018;127:1074–84.

    Article  Google Scholar 

  24. Chen Y, Jiang S, Wu Y. Effect of 2 different anesthesia methods on stress response in neurosurgical patients with hypertension or normal: a prospective clinical trial. Medicine (Baltimore). 2016;95:e4769.

    Article  CAS  Google Scholar 

  25. Nadler JW, Quinn TD, Bennett-Guerrero E. Can anesthesiologists affect cancer outcomes? Can J Anaesth. 2019;66:491–4.

    Article  Google Scholar 

  26. Jun IJ, Jo JY, Kim JI, Chin JH, Kim WJ, Kim HR, Lee EH, Choi IC. Impact of anesthetic agents on overall and recurrence-free survival in patients undergoing esophageal cancer surgery: a retrospective observational study. Sci Rep. 2017;7:14020.

    Article  Google Scholar 

  27. Soltanizadeh S, Degett TH, Gogenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: a systematic review. J Clin Anesth. 2017;42:19–25.

    Article  Google Scholar 

  28. Wigmore TJ, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology. 2016;124:69–79.

    Article  CAS  Google Scholar 

  29. Yoo S, Lee HB, Han W, Noh DY, Park SK, Kim WH, Kim JT. Total intravenous anesthesia versus inhalation anesthesia for breast cancer surgery: a retrospective cohort study. Anesthesiology. 2019;130:31–40.

    Article  CAS  Google Scholar 

  30. Bihorac A. Acute kidney injury in the surgical patient: recognition and attribution. Nephron. 2015;131:118–22.

    Article  Google Scholar 

  31. Birnie K, Verheyden V, Pagano D, Bhabra M, Tilling K, Sterne JA, Murphy GJ. Predictive models for kidney disease: improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery. Crit Care. 2014;18:606.

    Article  Google Scholar 

  32. Echarri G, Duque-Sosa P, Callejas R, Garcia-Fernandez N, Nunez-Cordoba JM, Iribarren MJ, Monedero P, The Renal Dysfunction in Cardiac Surgery Spanish Group (GEDRCC2). External validation of predictive models for acute kidney injury following cardiac surgery: a prospective multicentre cohort study external validation of predictive models for acute kidney injury following cardiac surgery: a prospective multicentre cohort study. Eur J Anaesthesiol. 2017;34:81–8.

    Article  CAS  Google Scholar 

  33. Englberger L, Suri RM, Li Z, Dearani JA, Park SJ, Sundt TM 3rd, Schaff HV. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis. 2010;56:623–31.

    Article  Google Scholar 

  34. Mehta RH, Grab JD, O’Brien SM, Bridges CR, Gammie JS, Haan CK, Ferguson TB, Peterson ED. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114:2208–16.

    Article  Google Scholar 

  35. Ng SY, Sanagou M, Wolfe R, Cochrane A, Smith JA, Reid CM. Prediction of acute kidney injury within 30 days of cardiac surgery. J Thorac Cardiovasc Surg. 2014;147:1875–83.

    Article  Google Scholar 

  36. Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162–8.

    Article  Google Scholar 

  37. Sanchez-Conde P, Rodriguez-Lopez JM, Nicolas JL, Lozano FS, Garcia-Criado FJ, Cascajo C, Gonzalez-Sarmiento R, Muriel C. The comparative abilities of propofol and sevoflurane to modulate inflammation and oxidative stress in the kidney after aortic cross-clamping. Anesth Analg. 2008;106:371–8.

    Article  CAS  Google Scholar 

  38. Rodriguez-Lopez JM, Sanchez-Conde P, Lozano FS, Nicolas JL, Garcia-Criado FJ, Cascajo C, Muriel C. Laboratory investigation: effects of propofol on the systemic inflammatory response during aortic surgery. Can J Anaesth. 2006;53:701–10.

    Article  Google Scholar 

  39. Li Y, Zhong D, Lei L, Jia Y, Zhou H, Yang B. Propofol prevents renal ischemia-reperfusion injury via inhibiting the oxidative stress pathways. Cell Physiol Biochem. 2015;37:14–26.

    Article  Google Scholar 

  40. Lee HT, Ota-Setlik A, Fu Y, Nasr SH, Emala CW. Differential protective effects of volatile anesthetics against renal ischemia-reperfusion injury in vivo. Anesthesiology. 2004;101:1313–24.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We specially thank Younghae Cho, B.S. (from the Department of Statistics, Sungkyunkwan University, Seoul, Korea) for his significant contribution to the statistical analyses in this work. This study used clinical data retrieved from Seoul National University Hospital Patients Research Environment (SUPREME) system.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea, 03080

    Bo Rim Kim, Susie Yoon, Gyu Young Song, Seohee Lee, Jae-Hyon Bahk & Karam Nam

Authors
  1. Bo Rim Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susie Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gyu Young Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seohee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jae-Hyon Bahk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karam Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BRK, J-HB, and KN: Conceptualization; Formal analysis and investigation: BRK, SY, GYS, SL, and KN; Writing—original draft preparation: BRK, J-HB, and KN; Writing—review and editing: SY, GYS, and SL; Supervision: J-HB.

Corresponding author

Correspondence to Karam Nam.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest.

Additional information

Publisher's Note

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

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, B.R., Yoon, S., Song, G.Y. et al. The impact of total intravenous anesthesia versus inhalation anesthesia on acute kidney injury after major abdominal surgery: a propensity score analysis. J Anesth 35, 112–121 (2021). https://doi.org/10.1007/s00540-020-02882-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-020-02882-9

Keywords

Search

Navigation