Acute Kidney Injury in the Age of Enhanced Recovery Protocols

Overview

Journal Dis Colon Rectum

Specialty Gastroenterology

Date 2018 Jul 12

PMID 29994959

Citations 9

Authors

Taryn E Hassinger

Florence E Turrentine

Robert H Thiele

Bethany M Sarosiek

Timothy L McMurry

Charles M Friel

Traci L Hedrick

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury is a prevalent complication after abdominal surgery. With increasing adoption of enhanced recovery protocols, concern exists for concomitant increase in acute kidney injury.

Objective: This study evaluated effects of enhanced recovery on acute kidney injury through identification of risk factors.

Design: This was a retrospective cohort study comparing acute kidney injury rates before and after implementation of enhanced recovery protocol.

Settings: The study was conducted at a large academic medical center.

Patients: All of the patients undergoing elective colorectal surgery between 2010 and 2016, excluding patients with stage 5 chronic kidney disease, were included.

Main Outcome Measures: Patients before and after enhanced recovery implementation were compared, with rate of acute kidney injury as the primary outcome. Acute kidney injury was defined as a rise in serum creatinine ≥1.5 times baseline within 30 days of surgery. Multivariable logistic regression identified risk factors for acute kidney injury.

Results: A total of 900 cases were identified, including 461 before and 439 after enhanced recovery; 114 cases were complicated by acute kidney injury, including 11.93% of patients before and 13.44% after implementation of enhanced recovery (p = 0.50). Five patients required hemodialysis, with 2 cases after protocol implementation. Multivariable logistic regression identified hypertension, functional status, ureteral stents, nonsteroidal anti-inflammatory drugs, operative time >200 minutes, and increased intravenous fluid administration on postoperative day 1 as predictors of acute kidney injury. Laparoscopic surgery decreased the risk of acute kidney injury. The enhanced recovery protocol was not independently associated with acute kidney injury.

Limitations: The study was limited by its retrospective and nonrandomized before-and-after design.

Conclusions: No difference in rates of acute kidney injury was detected before and after implementation of a colorectal enhanced recovery protocol. Independent predictors of acute kidney injury were identified and could be used to alter the protocol in high-risk patients. Future study is needed to determine whether protocol modifications will further decrease rates of acute kidney injury in this population. See Video Abstract at http://links.lww.com/DCR/A568.

Citing Articles

Impact of a kidney-adjusted ERAS protocol on postoperative outcomes in patients undergoing partial nephrectomy.

Walach M, Korner M, Weiss C, Terboven T, Muhlbauer J, Wessels F Langenbecks Arch Surg. 2024; 409(1):319.

PMID: 39441354 PMC: 11499443. DOI: 10.1007/s00423-024-03513-7.

Prophylactic ureteral stent in colorectal surgery: a meta-analysis and systematic review.

Pompeu B, de Arruda Ribeiro C, Pasqualotto E, Delgado L, Guedes L, Poli de Figueiredo S Int Urol Nephrol. 2024; 57(2):301-312.

PMID: 39379754 DOI: 10.1007/s11255-024-04224-0.

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic.

Lovely J, Larson D Healthcare (Basel). 2021; 9(5).

PMID: 34066696 PMC: 8150975. DOI: 10.3390/healthcare9050549.

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis.

Shen W, Wu Z, Wang Y, Sun Y, Wu A PLoS One. 2021; 16(5):e0251476.

PMID: 34015002 PMC: 8136724. DOI: 10.1371/journal.pone.0251476.

Association of plasma and urine NGAL with acute kidney injury after elective colorectal surgery: A cohort study.

Lumlertgul N, Ostermann M, McCorkell S, Van Dellen J, Williams A Ann Med Surg (Lond). 2021; 62:315-322.

PMID: 33552490 PMC: 7847815. DOI: 10.1016/j.amsu.2021.01.060.

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