Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Journal of Hospital Medicine - Tập 9 Số 5 - Trang 283-288 - 2014
Erik Nielson1, Eileen Hennrikus2, Erik Lehman3, Berend Mets4
1Department of Anesthesiology, Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
2Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center Department of Internal Medicine Hershey Pennsylvania
3Penn State Hershey College of Medicine, Department of Public Health Sciences, Hershey, Pennsylvania.
4Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center Department of Anesthesiology Hershey Pennsylvania

Tóm tắt

BACKGROUNDPatients presenting for surgery with angiotensin axis blockade (AAB) from therapy with either angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers experience an increased incidence of perioperative hypotension. Acute kidney injury (AKI) in patients receiving preoperative AAB has been demonstrated after lung, vascular, and cardiac surgery. However, there is little literature evaluating the hypotensive and renal effects of preoperative AAB and major orthopedic surgery.METHODSWe performed a retrospective chart review of 1154 patients who underwent spinal fusion, total knee arthroplasty, or total hip arthroplasty during the 2010 calendar year in our academic medical center.RESULTSA total of 922 patients met inclusion criteria, 343 (37%) received preoperative AAB. Postinduction hypotension (systolic blood pressure ≤80 mm Hg for 5 minutes) was significantly higher in patients receiving AAB when compared to those not so treated (12.2% vs 6.7%; odds ratio [OR]: 1.93, P = 0.005). Of the 922 patients, 798 had documented measurements of both preoperative and postoperative creatinine. Postoperative AKI was significantly higher in patients receiving AAB therapy (8.3% vs 1.7%; OR: 5.40, P < 0.001), remaining significant after adjusting for covariates including hypotension (OR: 2.60, P = 0.042). Developing AKI resulted in a significantly higher mean length of stay (5.76 vs 3.28 days, P < 0.001) but no difference in 2‐year mortality.CONCLUSIONSPatients undergoing major elective orthopedic surgery who receive preoperative AAB therapy,have an associated increased risk of postinduction hypotension and postoperative acute kidney injury resulting in a greater hospital length of stay. Journal of Hospital Medicine 2014;9:283–288. © 2014 Society of Hospital Medicine

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Journal of Hospital Medicine

Tập 9 Số 5

283-288

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