Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2019 Jan 27

PMID 30684001

Citations 6

Authors

Fabian Grass

Jenna K Lovely

Jacopo Crippa

Kellie L Mathis

Martin Hubner

David W Larson

Affiliations

Soon will be listed here.

Abstract

Background: The present study aimed to assess the impact of perioperative fluid management on early acute kidney injury (AKI) rate and long-term sequelae in patients undergoing elective colorectal procedures within an enhanced recovery pathway (ERP).

Methods: Retrospective analysis of consecutive patients from a prospectively maintained ERP database (2011-2015) is performed. Pre- and postoperative creatinine levels (within 24 h) were compared according to risk (preoperative creatinine rise ×1.5), injury (×2), failure (×3), loss of kidney function and end-stage kidney disease (RIFLE) criteria. Risk factors for early AKI were identified through logistic regression analysis, and long-term outcome in patients with AKI was assessed.

Results: Out of 7103 patients, 4096 patients (58%) with pre- and postoperative creatinine levels were included. Of these, 104 patients (2.5%) presented postoperative AKI. AKI patients received higher amounts of POD 0 fluids (3.8 ± 2.4 vs. 3.2 ± 2 L, p = 0.01) and had increased postoperative weight gain at POD 2 (6 ± 4.9 vs. 3 ± 2.7 kg, p = 0.007). Independent risk factors for AKI were high ASA score (ASA ≥ 3: OR 1.7; 95% CI 1.1-2.5), prolonged operating time (>180 min: OR 1.9; 95% CI 1.3-2.9) and diabetes mellitus (OR 2.5; 95% CI 1.5-4), while minimally invasive surgery was a protective factor (OR 0.6; 95% CI 0.4-0.9). Five patients (0.1%) developed chronic kidney disease, and two of them needed dialysis after a mean follow-up of 33.7 ± 22.4 months.

Conclusions: Early AKI was very uncommon in the present cohort of colorectal surgery patients treated within an ERP, and long-term sequelae were exceptionally low.

Citing Articles

Preoperative risk factors for ileostomy-associated kidney injury in colorectal tumor surgery following ileostomy formation.

Ota E, Watanabe J, Suwa H, Hirai T, Suwa Y, Nakagawa K Int J Colorectal Dis. 2024; 39(1):160.

PMID: 39397177 PMC: 11471691. DOI: 10.1007/s00384-024-04732-6.

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice.

Deslarzes P, Jurt J, Larson D, Blanc C, Hubner M, Grass F J Clin Med. 2024; 13(3).

PMID: 38337495 PMC: 10856154. DOI: 10.3390/jcm13030801.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews.

Parrish 2nd R, Bodenstab H, Carneal D, Cassity R, Dager W, Hyland S J Clin Med. 2022; 11(19).

PMID: 36233497 PMC: 9572852. DOI: 10.3390/jcm11195628.

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.

Male Patients may be More Vulnerable to Acute Kidney Injury After Colorectal Surgery in an Enhanced Recovery Program: A Propensity Score Matching Analysis.

Shim J, Ro H, Lee C, Park J, Lee H, Kim Y World J Surg. 2021; 45(6):1642-1651.

PMID: 33721072 DOI: 10.1007/s00268-021-06041-3.

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