title: The Influence of Propofol and Sevoflurane on Acute Kidney Injury After Colorectal Surgery: A Retrospective Cohort Study.
abstract: Acute kidney injury (AKI) is a primary cause of morbidity and mortality after major abdominal surgery; however, little is known about the effect of anesthetics on the development of AKI after colorectal surgery. The objective of this study was to compare the effects of anesthesia with propofol and sevoflurane on postoperative AKI after colorectal surgery.
  
  
  
  For this study, we reviewed the electronic medical records of 4320 patients who underwent colorectal surgeries between January 2008 and December 2011. The influence of propofol and sevoflurane on the development of postoperative AKI and short-term outcomes was assessed by multivariable analysis, and the effect of the anesthetic agent on overall mortality was analyzed by a Cox proportional hazard model with propensity score matching method.
  
  
  
  Overall, the incidence of AKI was 9.6% by Acute Kidney Injury Network (AKIN) criteria and 5.8% by risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria. The incidence of AKI incidence was greater in patients receiving sevoflurane than those receiving propofol (142 [11.2%] vs 272 [8.9%], P = 0.02 by AKIN criteria, 94 [7.4%] vs 157 [5.1%], P = 0.004 by RIFLE criteria). Multivariate logistic regression and propensity score matching results indicated that, when compared with propofol, sevoflurane anesthesia may be associated with the development of postoperative AKI (odds ratio [OR], 1.29; P = 0.03; and OR, 1.44; P = 0.02 by AKIN and RIFLE criteria, and OR, 1.41; P = 0.04 by RIFLE criteria, respectively). We found no relationship between sevoflurane and overall mortality.
  
  
  
  Compared with anesthesia with propofol, anesthesia with sevoflurane may be associated with a modest increase in the incidence of AKI when RIFLE but not AKIN criteria are used. Thus, the clinical meaning of these results is uncertain. Further work is needed to clarify the relevance of such an association.
authors.affiliation: From the *Department of Anaesthesiology and Pain Medicine and †Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Bang
authors.forename: JungBok
authors.initials: J
authors.lastname: Lee
authors.forename: Jimi
authors.initials: J
authors.lastname: Oh
authors.forename: Jun-Gol
authors.initials: JG
authors.lastname: Song
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D015742:Propofol / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012007:Rectum / Q000601:surgery*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol