Background: Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method: This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 7 days postoperatively in the hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results: Of the 74,284 surgeries, 4.4% (3159 cases) suffered acute kidney injury. The odds ratio for HDL (0.96–1.14 as reference, < 0.96, 1.14–1.35, > 1.35) was 1.28 (1.14–1.41), P < 0.001; 0.91 (0.80–1.03), P = 0.150; 0.75 (0.64–0.85), P < 0.001, respectively. Using a dichotomized cutoff point for propensity analysis, Preoperative serum HDL < 1.03 mmol/L (> 1.03 as reference) was associated with increased risk of postoperative AKI, with odds ratio 1.40 (1.27 ~ 1.52), P < 0.001 before propensity score weighting, and 1.32 (1.21–1.46), P < 0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions: Using multivariate regression analyses before and after propensity score weighting, in addition to multiple sensitivity analysis methods, this study found that following non-cardiac surgery, low HDL cholesterol levels were independent risk factors for AKI.

Background: Perioperative hemoglobin drop after noncardiac surgery is associated with acute kidney injury (AKI). However, opinion on the tolerable difference in postoperative hemoglobin drop in patients with different preoperative hemoglobin levels does not reach a consensus. This study aimed to identify hemoglobin drop thresholds for AKI after noncardiac surgery stratified by preoperative hemoglobin levels.Method: This was a single-center retrospective cohort study for elective noncardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The generalized additive model described the non-linear relationship between hemoglobin drop and AKI occurrence. The minimumP-value approach identified cut-off points of hemoglobin drop within postoperative 7 days for patients with or without preoperative anemia. Stratified by preoperative anemia, hemoglobin drop’s odds ratio as continuous, quintile and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting (PSW).Results: Of the 35,631 surgery, 5.9% (2105 cases) suffered postoperative AKI. Non-linearity was found between hemoglobin drop and postoperative AKI occurrence. The thresholds and corresponding odds ratio of perioperative hemoglobin drop for patients with and without preoperative anemia were 18 g/L (1.38 (95%CI 1.14 -1.62),P < .001; after PSW: 1.42 (95%CI 1.17 -1.74),P < .001) and 43 g/L (1.81 (95%CI 1.35—2.27),P < .001; after PSW: 2.88 (95%CI 1.85—4.50),P < .001) respectively. Overall thresholds and corresponding odds ratio were 43 g/L (1.82 (95%CI 1.42—2.21)),P < .001; after PSW: 3.29 (95%CI 2.00—5.40),P < .001). Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that intraoperatively female patients undergoing intraperitoneal surgery without colloid infusion seemed to be more vulnerable to higher hemoglobin drop. Further analysis showed a possible linear relationship between preoperative hemoglobin and perioperative hemoglobin drop thresholds. Additionally, this study found that the creatinine level changed simultaneously with hemoglobin level within five postoperative days.Conclusions: Heterogeneity of hemoglobin drop endurability exists after noncardiac non-kidney surgery. More care and earlier intervention should be put on patients with preoperative anemia.

Handover of anesthesia care is often required in busy clinical settings. Herein, we investigated whether intraoperative anesthesia handover was associated with an increased risk of major adverse cardiovascular events (MACEs) after thoracic surgery. A retrospective cohort study. A tertiary hospital. Adult patients who underwent elective thoracic surgery. A complete handover of intraoperative anesthesia care was defined when the outgoing anesthesiologist transferred patient care to the incoming anesthesiologist and no longer returned. Our primary endpoint was a composite of MACEs, including acute myocardial infarction, new-onset congestive heart failure, non-fatal cardiac arrest, and cardiac death, that occurred within 7 days after surgery. The impact of complete anesthesia handover on postoperative MACEs was analyzed using propensity score matching. Of 6962 patients (mean age 59.7 years; 57.4 % female) included in the analysis, 2319 (33.3 %) surgeries were conducted with anesthesia handover whereas 4643 (66.7 %) were conducted without. After propensity score matching, 2165 (50.0 %) surgeries were conducted with anesthesia handover whereas the other half were conducted without. Patients with anesthesia handover developed more MACEs when compared with those without (10.4 % [225/2165] vs. 8.4 % [181/2165]; relative risk 1.24, 95 % CI 1.03 to 1.50, P = 0.022). Specifically, myocardial infarction was more common in patients with anesthesia handover than in those without (9.2 % [199/2165] vs. 7.4 % [160/2165]; relative risk 1.24, 95 % CI 1.02 to 1.52, P = 0.032). For adult patients undergoing thoracic surgery, a complete handover of intraoperative anesthesia care was associated with an increased risk of MACEs after surgery.

Background: Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method: This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 7 days postoperatively in the hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results: Of the 74284 surgeries, 4.4% (3159 cases) suffered acute kidney injury. The odds ratio for HDL (0.96-1.14 as reference, < 0.96, 1.14 -1.35, > 1.35) was 1.28 (1.14 - 1.41), P < 0.001; 0.91 (0.80 - 1.03), P = 0.150; 0.75 (0.64 - 0.85), P < 0.001, respectively. Using a dichotomized cutoff point for propensity analysis, Preoperative serum HDL < 1.03 mmol/L (> 1.03 as reference) was associated with increased risk of postoperative AKI, with odds ratio 1.32 (1.21 - 1.46), P < 0.001 before propensity score weighting, and 1.32 (1.18 - 1.48), P < 0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions: Using multivariate regression analyses before and after propensity score weighting, in addition to multiple sensitivity analysis methods, this study found that following non-cardiac surgery, low HDL cholesterol levels were independent risk factors for AKI.

Background: Recently, it has been under consideration that the anesthetic techniques used during general anesthesia may have influence over the development of acute kidney injury and other postoperative outcomes. For this reason, we aimed to compare the effects of different regional blockade techniques (peripheral nerve blockade versus neuraxial epidural) on occurrence of acute kidney injury (AKI) after thoracic and abdominal surgeries under general anesthesia.Methods: In a single-center retrospective cohort study, 2846 patients undergoing elective thoracic or abdominal surgery during a period of seven years were included into the study. The primary endpoint was the occurrence of AKI postoperatively within a seven-day period in-hospital. Perioperative data were obtained and analyzed to provide data for secondary endpoints that include all other outcome related parameters. To reduce the influence of potential confounding factors, propensity score (PS) analysis was performed. Multivariate logistic regression models examined the selection of an epidural or PNB in general anesthesia before and after propensity score weighting analysis.Results: Of the 2846 patients, 7.3% (207 cases) suffered AKI. The odds ratio of AKI for PNB (epidural as reference) was 0.61 (0.40~0.83), P = 0.006. After propensity score matching, the odds ratio for PNB was [0.49 (0.28~0.70), P = 0.001]. All other outcome related parameters were considered and evaluated.Conclusions: After PS matching analysis, there is no difference in secondary outcome analysis of groups that received PNB or epidural neuraxial blockade who were both under general anesthesia. However, patients who received PNB under general anesthesia showed lower incidence of AKI within seven days postoperatively.

Background: Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method: This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 30 days postoperatively in hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results: Of the 74284 surgeries, 4.2% (3159 cases) suffered acute kidney injury. Preoperative serum HDL was associated with postoperative AKI, with odds ratio (0.96-1.14 as reference, 1.35 mmol/L, Quartile) 1.27 (1.15~1.39), P <.001; 0.90 (0.80~1.01), P= .086; 0.75 (0.65~0.85), P <.001, respectively. Preoperative serum HDL <1.03 mmol/L was associated with increased risk of postoperative AKI, with odds ratio 1.32 (1.21~1.46), P<0.001 before propensity score weighting, and 1.32 (1.18~1.48), P<0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions: Postoperative acute kidney injury occurred in 4.2 % of patients undergoing elective non-cardiac non-kidney surgery. This study found that low HDL cholesterol levels were independent risk factors for AKI after non-cardiac surgery.