Does the choice of intraoperative fluid modify abdominal aneurysm repair outcomes?: A cohort analysis

• Published in: Medicine (Baltimore) Vol. 98; no. 28; p. e16387
• Main Authors: Bernardi, Martin H, Haider, Dominik G, Domenig, Christoph M, Ristl, Robin, Hagmann, Michael, Haisjackl, Markus, Hiesmayr, Michael J, Lassnigg, Andrea
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.07.2019
• Subjects: Acute Kidney Injury - epidemiology; Administration, Intravenous; Aged; Aortic Aneurysm, Abdominal - epidemiology; Aortic Aneurysm, Abdominal - surgery; Cohort Studies; Endovascular Procedures; Female; Humans; Male; Middle Aged; Observational Study; Perioperative Care - methods; Postoperative Complications - epidemiology; Risk Factors; Starch - therapeutic use; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000016387

Intraoperatively administered hydroxyethyl starch could be a risk indicator for postoperative acute kidney injury (AKI) in vascular surgical patients.In a single-center retrospective cohort analysis, we assessed the impact of hydroxyethyl starch and other risk indicators on AKI and mortality in 1095 patients undergoing elective open abdominal aneurysm repair (AAA-OR) or endovascular aortic repair (EVAR). We established logistic regression models to determine the effect of various risk indicators, including hydroxyethyl starch, on AKI, as well as Cox proportional hazard models to assess the effect on mortality.The use of intravenous hydroxyethyl starch was not associated with an increased risk of AKI or mortality. Patients undergoing EVAR were less likely to develop AKI (4% vs 18%). Multivariate risk indicators associated for AKI included suprarenal or pararenal aortic cross-clamp [odds ratio (OR), 4.44; 95% confidence interval (95% CI), 2.538-7.784; P < .001] and procedure length (OR, 1.005; 95% CI, 1.003-1.007; P < .001), and favored EVAR (OR, 0.351; 95% CI, 0.118-0.654; P < .01). Main multivariate risk indicators associated with mortality included patients needing an urgent procedure [hazard ratio (HR), 2.294; 95% CI, 1.541-3.413; P < .001], those with suprarenal or pararenal aortic cross-clamp (HR, 1.756; 95% CI, 1.247-2.472; P < .01), and patients undergoing EVAR (HR, 1.654; 95% CI, 1.292-2.118; P < .001).We found neither a benefit nor a negative effect of hydroxyethyl starch on the risk of AKI or mortality. Instead, other variables and comorbidities were found to be relevant for the development of postoperative AKI and survival. Nevertheless, clinicians should be aware of the high risk of postoperative AKI, particularly among those undergoing AAA-OR procedures.