Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study

Background: Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to post-operative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who un-derwent PD and evaluated IOH as a factor associated with AKI. Material/Methods: We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO cri-teria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean ar-terial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regres-sion models with previously established independent variables. Results: We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. Conclusions: In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.