TY - JOUR
T1 - Caution
T2 - Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols
AU - Koerner, Crystal P.
AU - Lopez-Aguiar, Alexandra G.
AU - Zaidi, Mohammad
AU - Speegle, Shelby
AU - Balch, Glen
AU - Shaffer, Virginia O.
AU - Staley, Charles A.
AU - Srinivasan, Jahnavi
AU - Maithel, Shishir K.
AU - Sullivan, Patrick S.
N1 - Publisher Copyright:
© 2019 Southeastern Surgical Congress. All Rights Reserved.
PY - 2019
Y1 - 2019
N2 - Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P 5 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3-9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6-16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5-5.8; P < 0.01). On multivariable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5-7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P 5 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.
AB - Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P 5 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3-9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6-16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5-5.8; P < 0.01). On multivariable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5-7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P 5 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.
UR - http://www.scopus.com/inward/record.url?scp=85062380375&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062380375&partnerID=8YFLogxK
M3 - Article
C2 - 30819291
AN - SCOPUS:85062380375
SN - 0003-1348
VL - 85
SP - 156
EP - 161
JO - American Surgeon
JF - American Surgeon
IS - 2
ER -