The association between intraoperative hypotension and postoperative acute kidney injury following emergent critical cesarean delivery: a retrospective cohort study

This retrospective cohort study aimed to investigate the association between intraoperative hypotension (IOH) and postoperative acute kidney injury (AKI) among patients who underwent emergent critical cesarean delivery. We analyzed electronic health records from January 2019 to August 2024. IOH was defined as a mean arterial pressure (MAP) less than 65 mmHg. It was quantified using four metrics: hypotensive event count, cumulative duration, area under the threshold (AUC), and time-weighted average (TWA). Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines, based on serum creatinine levels. We employed multivariable logistic regression to assess the independent association between the primary IOH metric (cumulative duration) and postoperative AKI, adjusting for clinically relevant covariates. Sensitivity analyses were conducted using alternative IOH metrics. Postoperative AKI was diagnosed in 69 of the 508 patients (13.58%). Multivariable logistic regression analysis revealed that all four measures of intraoperative hypotension were independently associated with an increased risk of AKI: hypotensive event count (adjusted OR 2.098, 95%CI [1.180–3.732]; P = 0.012), cumulative duration (adjusted OR 1.036, 95%CI [1.013–1.060]; P = 0.002), AUC (adjusted OR 1.004, 95%CI [1.001–1.007]; P = 0.009), and TWA (adjusted OR 1.557, 95%CI [1.058–2.291]; P = 0.025). Our findings demonstrate that IOH was independently associated with a higher incidence of postoperative AKI in patients who underwent an emergent critical cesarean delivery.