Intraoperative Hypotension Is Not Correlated With Acute Kidney Injury During Spinal Fusion Surgery

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Figure 1
Forest plot of unadjusted odds ratios between postoperative outcomes and (A) occurrence of intraoperative hypotension, (B) intraoperative hypotension lasting for 10 min or longer, and (C) duration of intraoperative hypotension.
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Figure 2
Forest plot of adjusted odds ratios between postoperative outcomes and (A) occurrence of intraoperative hypotension, (B) intraoperative hypotension lasting for 10 min or longer, and (C) duration of intraoperative hypotension.

Table 1

Summary of patient cohort.

Variable	Count (%)
Demographics
Age, y, mean	61.6
Men	415 (48.9)
Outcomes
Intraoperative hypotension	838 (92.1)
Intraoperative hypotension >10 min	621 (68.2)
Acute kidney injury	36 (4.0)
Ileus	47 (5.2)
Readmission	119 (13.1)
Return to operating room within 30 d	55 (6.1)
Troponin leak occurrence	14 (1.5)
Total intraoperative hypotension time, min, mean	34.7
Estimated blood loss, mean	479.3
Postoperative creatinine to preoperative creatinine ratio, mean	0.9
Length of hospital stay, d, mean	6.9

Table 2

Partial correlation coefficients and P values between variables of interest and outcomes.

Dependent Variable	IOH Occurrence^{^a}		IOH Duration >10 min^{^a}		Total IOH Time^{^b}		Age at Surgery^{^b}		Preoperative Creatinine^{^b}
Dependent Variable	P Value	Coefficient	P Value	Coefficient	P Value	Coefficient	P Value	Coefficient	P Value	Coefficient
Acute kidney injury	0.475	0.025	0.859	−0.006	0.942	−0.003	0.232	0.043	0.946	0.002
Ileus	0.846	0.007	0.705	0.013	0.403	0.030	0.654	−0.016	0.814	−0.009
Postoperative creatinine ratio	0.240	−0.041	0.367	−0.031	0.197	0.047	0.892	0.005	0.001^{^c}	−0.126
Postoperative troponin leak	0.211	0.043	0.506	0.023	0.139	0.054	0.038	0.075	0.020	−0.084
Length of stay	0.709	−0.013	0.4230	0.027	0.467	0.026	0.390	−0.031	0.824	−0.008
Readmission	0.562	0.020	0.941	−0.003	0.008	−0.096	0.264	0.041	0.165	0.050
Return to operating room	0.332	0.034	0.482	−0.024	0.038	−0.075	0.152	0.052	0.311	−0.037
Estimated blood loss	0.262	0.039	0.001	0.111	<0.001^{^c}	0.120	0.975	0.001	0.976	0.001
Any complications	0.251	0.040	0.081	0.061	0.957	0.002	0.767	0.011	0.093	−0.061
Any fluids administered	0.728	−0.012	0.955	−0.002	0.108	−0.058	0.784	−0.010	0.632	0.017
Any pressors used	<0.001^{^c}	0.142	<0.001^{^c}	0.160	0.111	0.058	0.598	0.019	0.633	−0.017

Table 3

Nonadjusted odds ratios for association of intraoperative hypotension and outcomes.

Variable	Nonadjusted OR (95% CI)
Variable	IOH	IOH >10 min	IOH Duration
Acute kidney injury	0.67 (0.06–7.79)	1.07 (0.32–3.55)	1.00 (0.98–1.02)
Any complication	0.59 (0.17–1.98)	0.74 (0.39–1.38)	1.00 (0.99–1.01)
Fluid administration	1.82 (0.06–55.79)	1.25 (0.25–6.21)	1.01 (0.99–1.02)
Vasopressor administration	0.32 (0.14–0.74)	0.45 (0.26–0.78)	0.99 (0.99–1.00)
Ileus	0.78 (0.10–5.92)	1.11 (0.39–3.18)	1.00 (0.99–1.02)
Troponin leak occurrence	NA^{^a}	0.85 (0.12–6.17)	0.99 (0.98–1.01)
Readmission	0.70 (0.18–2.72)	0.88 (0.43–1.79)	1.01 (1.00–1.02)
Return to operating room within 30 d	0.42 (0.04–4.77)	1.24 (0.47–3.24)	1.01 (0.99–1.03)

Abbreviation: IOH, intraoperative hypotension.
Note: Boldface indicates statistically significant findings.
↵a Not available; OR for IOH and troponin leak occurrence could not be calculated due to low sample size.

Table 4

Adjusted odds ratios for association of intraoperative hypotension and outcomes.

Variable	Adjusted OR (95% CI)
Variable	IOH	IOH >10 min	IOH Duration
Acute kidney injury	0.74 (0.06–8.78)	1.10 (0.32–3.80)	1.00 (0.98–1.02)
Any complication	0.60 (0.18–2.04)	0.73 (0.39–1.38)	1.00 (0.99–1.01)
Fluid administration	1.68 (0.05–51.71)	1.21 (0.24–6.05)	1.01 (0.99–1.02)
Vasopressor administration	0.33 (0.14–0.78)	0.46 (0.26–0.81)	0.99 (0.99–1.00)
Ileus	0.79 (0.10–5.96)	1.07 (0.37–3.07)	1.00 (0.99–1.01)
Troponin leak occurrence	NA^{^a}	0.87 (0.12–6.64)	0.99 (0.97–1.01)
Readmission	0.72 (0.18–2.82)	0.86 (0.42–1.78)	1.01 (1.00–1.02)
Return to operating room within 30 d	0.44 (0.04–5.00)	1.23 (0.46–3.28)	1.01 (0.99–1.03)

Abbreviation: IOH, intraoperative hypotension.
Note: Boldface indicates statistically significant findings.
↵a Not available; odds ratios for IOH and troponin leak occurrence could not be calculated due to low sample size.