Intraoperative hypotension and postoperative acute kidney injury or myocardial injury after liver resection: A protocol for a systematic review and meta-analysis

Background

Liver resection creates a clinical tension between limiting operative bleeding and maintaining organ perfusion. Low central venous pressure, fluid restriction, vascular inflow occlusion and vasoactive treatment can coincide with lower arterial pressure, yet existing reviews have centred on blood loss and transfusion. They have not resolved whether directly quantified intraoperative hypotension is associated with postoperative acute kidney injury or myocardial injury, or whether comparative haemodynamic strategies alter these outcomes. We will address both questions while keeping exposure associations distinct from management effects and kidney outcomes distinct from myocardial outcomes.