Liberal Fluid Therapy Increases Postoperative Acute Kidney Injury in Patients Undergoing Laparoscopic Sleeve Gastrectomy with Dexmedetomidine

Abstract

Background Bariatric surgery is associated with a higher incidence of postoperative acute kidney injury (AKI) compared to non-bariatric procedures. Dexmedetomidine has been shown to reduce the risk of postoperative AKI in non-bariatric surgeries. This study aimed to determine whether intraoperative dexmedetomidine reduces the risk of postoperative AKI in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to assess the impact of intraoperative fluid therapy rates on AKI risk. Methods This study analysed 567 adult patients who underwent LSG between January 2019 and December 2022. Patients were divided into two groups based on intraoperative dexmedetomidine administration: the DEX group and the control group. Postoperative AKI was defined according to the Kidney Disease Improving Global Outcome criteria. Results Postoperative AKI occurred in 2.5% of patients, with no significant difference between the DEX and control groups (p = 0.541). However, within the DEX group, patients who received liberal intraoperative fluid therapy (>= 5 mL/kg/h) had a significantly higher incidence of AKI compared to those who received restrictive fluid therapy (< 5 mL/kg/h) (7.1% vs. 0.7%, p = 0.018). In multivariate regression analysis, an increased fluid therapy rate was significantly associated with postoperative AKI within the DEX group (odds ratio [OR], 1.969; 95% confidence interval [CI], 1.200-3.417; p = 0.008). In contrast, no significant association was observed between fluid therapy rate and postoperative AKI in the control group (p = 0.624). Conclusions Liberal, rather than, restrictive fluid therapy is associated with increased risk of postoperative AKI in patients undergoing LSG with dexmedetomidine.