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BioMed Research International
Volume 2014, Article ID 917985, 6 pages
http://dx.doi.org/10.1155/2014/917985
Clinical Study

May Renal Resistive Index Be an Early Predictive Tool of Postoperative Complications in Major Surgery? Preliminary Results

1Department of Anesthesia and Intensive Care Unit, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milano), Italy
2Cardiac Surgery Anesthesia Unit, Sant’Ambrogio Clinical Institute, Milano, Italy
3Biostatistic Unit, Humanitas Research Hospital, Rozzano (Milano), Italy

Received 4 February 2014; Revised 1 April 2014; Accepted 28 April 2014; Published 20 May 2014

Academic Editor: John J. Gildea

Copyright © 2014 Enrico Giustiniano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Patients who undergo high-risk surgery represent a large amount of post-operative ICU-admissions. These patients are at high risk of experiencing postoperative complications. Renal Resistive Index was found to be related with renal dysfunction, hypertension, and posttraumatic hemorrhagic shock, probably due to vasoconstriction. We explored whether Renal Resistive Index (RRI), measured after awakening from general anesthesia, could have any relationship with postoperative complications. Methods. In our observational, stratified dual-center trial, we enrolled patients who underwent general anesthesia for high-risk major surgery. After awakening in recovery room (or during awakening period in subjects submitted to cardiac surgery) we measured RRI by echo-color-Doppler method. Primary endpoint was the association of altered RRI (>0.70) and outcome during the first postoperative week. Results. 205 patients were enrolled: 60 (29.3%) showed RRI > 0.70. The total rate of adverse event was 27 (18.6%) in RRI ≤ 0.7 group and 19 (31.7%) in RRI > 0.7 group ( ). Significant correlation between RRI > 0.70 and complications resulted in pneumonia ( ), septic shock ( ), and acute renal failure ( ) subgroups. Patients with RRI > 0.7 showed longer ICU stay ( ) and lasting of mechanical ventilation ( ). These results were confirmed in cardiothoracic surgery subgroup. RRI > 0.7 duplicates triplicates the risk of complications, both in general (OR 2.03 93 95% CI 1.02–4.02, ) and in cardiothoracic (OR 2.62 95% CI 1.11–6.16, ) population. Furthermore, we found RRI > 0.70 was associated with a triplicate risk of postoperative septic shock (OR 3.04, CI 95% 1.5–7.01; ).