Comparison of acute kidney injury between open and laparoscopic liver resection: Propensity score analysis

<div><p>The inflammatory response has been shown to be a major contributor to acute kidney injury. Considering that laparoscopic surgery is beneficial in reducing the inflammatory response, we compared the incidence of postoperative acute kidney injury between laparoscopic liver resection and open liver resection. Among 1173 patients who underwent liver resection surgery, 222 of 926 patients who underwent open liver resection were matched with 222 of 247 patients who underwent laparoscopic liver resection, by using propensity score analysis. The incidence of postoperative acute kidney injury assessed according to the creatinine criteria of the Kidney Disease: Improving Global Outcomes definition was compared between those 1:1 matched groups. A total 77 (6.6%) cases of postoperative acute kidney injury occurred. Before matching, the incidence of acute kidney injury after laparoscopic liver resection was significantly lower than that after open liver resection [1.6% (4/247) vs. 7.9% (73/926), <i>P</i> < 0.001]. After 1:1 matching, the incidence of postoperative acute kidney injury was still significantly lower after laparoscopic liver resection than after open liver resection [1.8% (4/222) vs. 6.3% (14/222), <i>P</i> = 0.008; odds ratio 0.273, 95% confidence interval 0.088–0.842, <i>P</i> = 0.024]. The postoperative inflammatory marker was also lower in laparoscopic liver resection than in open liver resection in matched set data (white blood cell count 12.7 ± 4.0 × 10³/μL vs. 14.9 ± 3.9 × 10³/μL, <i>P</i> < 0.001). Our findings suggest that the laparoscopic technique, by decreasing the inflammatory response, may reduce the occurrence of postoperative acute kidney injury during liver resection surgery.</p></div

Patient demographics and perioperative variables before and after matching.

<p>Patient demographics and perioperative variables before and after matching.</p

Comparison of postoperative acute kidney injury.

<p>The overall incidence of postoperative acute kidney injury was significantly lower after laparoscopic liver resection than after open liver resection. This result was consistent between (a) before and (b) after matching. LLR, laparoscopic liver resection; OLR, open liver resection.</p

Univariate and multivariate analyses for postoperative acute kidney injury.

<p>Univariate and multivariate analyses for postoperative acute kidney injury.</p

Comparison of perioperative inflammatory markers.

<p>Comparison of maximum neutrophil-to-lymphocyte ratio and white blood cell count within postoperative day 7 between laparoscopic and open liver resection (a, c) before and (b, d) after matching. In matched set data, white blood cell count was significantly lower in the LLR group during the first postoperative week. LLR, laparoscopic liver resection; OLR, open liver resection; WBC, white blood cell; POD, postoperative day.</p

Comparison of inflammatory markers, kidney outcome, and hospital course.

<p>Comparison of inflammatory markers, kidney outcome, and hospital course.</p

Study flow diagram.

<p>Study flow diagram.</p

Survival curve according to the occurrence of postoperative AKI.

<p>Survival plot with Cox regression model demonstrated a significantly higher survival rate among patients with postoperative AKI (a) before (b) after matching. AKI, acute kidney injury.</p