Impact of intraoperative hypotension during laparoscopic liver resection on postoperative complications including acute kidney injury.

Background: Postoperative acute kidney injury is associated with an increase in hospital length of stay and mortality. Intraoperative hemodynamics and fluid management may contribute to acute kidney injury. The aim of this study is to evaluate the association between intraoperative duration of hypotension with adverse events after laparoscopic liver resection.

Methods: A prospective cohort including adult patients undergoing laparoscopic liver resection between January 2010 and June 2022. Cumulative time below mean arterial blood pressure thresholds and association with major adverse events composing of postoperative acute kidney injury (≤2 days) and complications (Dindo-Clavien ≥3a) ≤30 days were assessed.

Results: In 360 patients, the median age was 61 years, 206 (57%) were male, median body mass index was 26.3, and 129 (36%) patients had hepatocellular carcinoma. Acute kidney injury was recorded in 3 (0.8%) patients as stage 1, 6 (1.7%) patients as stage 2, and 7 (1.9%) patients as stage 3. Major adverse events occurred in 31 (8.6%) patients, and the median estimated blood loss was 200 mL. On continuous analysis, a threshold <60 mmHg at ≥15 minutes was found for major adverse events. The mean arterial blood pressure <55 mmHg for ≥20 minutes was associated with an increased risk of major adverse events (odds ratio 7.72; P < .001). In patients with >15 minutes of mean arterial blood pressure <60 mmHg, higher intravenous volume was associated with increase in major adverse events (P = .045), whereas adjusted intravenous volume was not associated with major adverse events (P = .657), acute kidney injury (P = .681), or blood loss (P = .875).

Conclusions: Laparoscopic liver resection is a safe procedure with a low risk of acute kidney injury. After ≥15 minutes at mean arterial blood pressure <60 mmHg, the risk of major adverse events increases. Greater intravenous fluid infusion volume was associated with an observed risk for major adverse events, suggesting that mean arterial blood pressure should be managed by vasoactive agents.