Top

International Journal of Colorectal Disease

Published in:

01-09-2018 | Original Article

Acute kidney injury following implementation of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery

Authors: Joseph H. Marcotte, Kinjal Patel, Ronak Desai, John P. Gaughan, Deviney Rattigan, Kevin W. Cahill, Robin F. Irons, Justin Dy, Monika Dobrowolski, Helena McElhenney, Michael Kwiatt, Steven McClane

Published in: International Journal of Colorectal Disease | Issue 9/2018

Abstract

Purpose

Fluid management within Enhanced Recovery After Surgery (ERAS) protocols is designed to maintain a euvolemic state avoiding the negative sequelae of hypervolemia or hypovolemia. We sought to determine the effect of a recent ERAS protocol implementation on kidney function and on the incidence of postoperative acute kidney injury (AKI).

Methods

A total of 132 elective colorectal resections performed using our ERAS protocol were compared to a propensity-matched group prior to ERAS implementation. Fluid balance, urine output, creatinine, and blood urea nitrogen (BUN) were recorded for all patients, and the incidence of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results

Implementation of our ERAS protocol decreased average postoperative length of hospital stay (5.5 vs 7.7 days, p < 0.0001) and time to return of bowel function (2.5 vs 4.1 days, p < 0.0001). The rate of postoperative AKI increased following implementation of the protocol (11.4 vs 2.3%, p < 0.0001). However, by the time of discharge, the average creatinine of ERAS patients who had experienced AKI had returned to their preoperative baseline values (p = 0.9037). Significant univariate predictors of AKI in ERAS patients were longer operative times (p < 0.01) and the diagnosis of diverticulitis (p < 0.01). Within our ERAS patients, AKI was associated with a prolonged postoperative length of hospital stay (p < 0.01).

Conclusions

Despite the proven benefits of the Enhanced Recovery After Surgery (ERAS) protocols, care should be taken during protocol implementation to monitor for and to prevent acute kidney injury.

Kehlet H, Bundgaard-Nielsen M (2009) Goal-directed perioperative fluid management: why, when, and how? Anesthesiology 110(3):453–455. https://doi.org/10.1097/ALN.0b013e3181984217 CrossRefPubMed

Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188. https://doi.org/10.1002/bjs.9394 CrossRefPubMed

Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56(5):667–678. https://doi.org/10.1097/DCR.0b013e3182812842 CrossRefPubMed

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, CE MN, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O, Enhanced Recovery After Surgery Society fPC, European Society for Clinical N, Metabolism, International Association for Surgical M, Nutrition (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS((R))) society recommendations. World J Surg 37(2):259–284. https://doi.org/10.1007/s00268-012-1772-0 CrossRefPubMed

Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, Ljungqvist O, Soop M, Ramirez J, Enhanced Recovery After Surgery S (2012) Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS(R)) society recommendations. Clin Nutr 31(6):801–816. https://doi.org/10.1016/j.clnu.2012.08.012 CrossRefPubMed

Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR (2017) Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60(8):761–784. https://doi.org/10.1097/DCR.0000000000000883 CrossRefPubMed

Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, Cannesson M, Gan TJ, Mythen MM, Shaw AD, Miller TE, Perioperative Quality Initiative IW (2016) American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med (Lond) 5:24. https://doi.org/10.1186/s13741-016-0049-9 CrossRef

Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97(4):820–826CrossRefPubMed

Giglio MT, Marucci M, Testini M, Brienza N (2009) Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 103(5):637–646. https://doi.org/10.1093/bja/aep279 CrossRefPubMed

10.

Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, Optimisation Systematic Review Steering G (2013) Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review. Br J Anaesth 111(4):535–548. https://doi.org/10.1093/bja/aet155 CrossRefPubMed

11.

Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM (2012) Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 114(3):640–651. https://doi.org/10.1213/ANE.0b013e318240d6eb CrossRefPubMed

12.

Noblett SE, Snowden CP, Shenton BK, Horgan AF (2006) Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 93(9):1069–1076. https://doi.org/10.1002/bjs.5454 CrossRefPubMed

13.

Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR, Fleming SC (2005) Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 95(5):634–642. https://doi.org/10.1093/bja/aei223 CrossRefPubMed

14.

Chan DK, Parikh SR (2014) Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children. Laryngoscope 124(8):1789–1793. https://doi.org/10.1002/lary.24555 CrossRefPubMed

15.

Warth LC, Noiseux NO, Hogue MH, Klaassen AL, Liu SS, Callaghan JJ (2016) Risk of acute kidney injury after primary and revision total hip arthroplasty and total knee arthroplasty using a multimodal approach to perioperative pain control including ketorolac and celecoxib. J Arthroplast 31(1):253–255. https://doi.org/10.1016/j.arth.2015.08.012 CrossRef

16.

Torregrosa-de Juan E, Olague-Diaz P, Royo-Maicas P, Fernandez-Najera E, Garcia-Maset R (2012) Acute renal failure due to gabapentin. A case report and literature. Nefrologia 32(1):130–131. https://doi.org/10.3265/Nefrologia.pre2011.Nov.11087 PubMedCrossRef

17.

Kheterpal S, Tremper KK, Heung M, Rosenberg AL, Englesbe M, Shanks AM, Campbell DA Jr (2009) Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology 110(3):505–515. https://doi.org/10.1097/ALN.0b013e3181979440 CrossRefPubMed

18.

Lim SY, Lee JY, Yang JH, Na YJ, Kim MG, Jo SK, Cho WY (2016) Predictive factors of acute kidney injury in patients undergoing rectal surgery. Kidney Res Clin Pract 35(3):160–164. https://doi.org/10.1016/j.krcp.2016.05.006 CrossRefPubMedPubMedCentral

19.

Masoomi H, Carmichael JC, Dolich M, Mills S, Ketana N, Pigazzi A, Stamos MJ (2012) Predictive factors of acute renal failure in colon and rectal surgery. Am Surg 78(10):1019–1023PubMed

20.

Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF (2000) Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 43(1):83–91CrossRefPubMed

21.

Kuper M, Gold SJ, Callow C, Quraishi T, King S, Mulreany A, Bianchi M, Conway DH (2011) Intraoperative fluid management guided by oesophageal Doppler monitoring. BMJ 342:d3016. https://doi.org/10.1136/bmj.d3016 CrossRefPubMed

22.

Group KDIGOKAKIW (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Inter 2

23.

Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262(3):416–425; discussion 423-415. https://doi.org/10.1097/SLA.0000000000001416 CrossRefPubMed

24.

Chun YJPM, Kim JS, Kim HK, Cho YS, Chae HS, Han SW, Choi KY, Lee HK (2007) Acute renal failure caused by oral polyethylene glycol ingestion. Clin Endosc 34(3):161–163

25.

Choi NK, Lee J, Chang Y, Jung SY, Kim YJ, Lee SM, Lee JH, Kim JY, Song HJ, Park BJ (2013) Polyethylene glycol bowel preparation does not eliminate the risk of acute renal failure: a population-based case-crossover study. Endoscopy 45(3):208–213. https://doi.org/10.1055/s-0032-1326031 CrossRefPubMed

26.

Heher EC, Thier SO, Rennke H, Humphreys BD (2008) Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation. Clin J Am Soc Nephrol 3(5):1494–1503. https://doi.org/10.2215/CJN.02040408 CrossRefPubMedPubMedCentral

27.

Brunelli SM, Lewis JD, Gupta M, Latif SM, Weiner MG, Feldman HI (2007) Risk of kidney injury following oral phosphosoda bowel preparations. J Am Soc Nephrol 18(12):3199–3205. https://doi.org/10.1681/ASN.2007040440 CrossRefPubMed

28.

Ma RC, Chow CC, Yeung VT, So WY, Kong AP, Tong PC, Cockram CS, Chan JC (2007) Acute renal failure following oral sodium phosphate bowel preparation in diabetes. Diabetes Care 30(1):182–183. https://doi.org/10.2337/dc06-2040 CrossRefPubMed

29.

Kim M, Brady JE, Li G (2014) Variations in the risk of acute kidney injury across intraabdominal surgery procedures. Anesth Analg 119(5):1121–1132. https://doi.org/10.1213/ANE.0000000000000425 CrossRefPubMed

30.

Biteker M, Dayan A, Tekkesin AI, Can MM, Tayci I, Ilhan E, Sahin G (2014) Incidence, risk factors, and outcomes of perioperative acute kidney injury in noncardiac and nonvascular surgery. Am J Surg 207(1):53–59. https://doi.org/10.1016/j.amjsurg.2013.04.006 CrossRefPubMed

31.

Meersch M, Schmidt C, Zarbock A (2017) Perioperative acute kidney injury: an under-recognized problem. Anesth Analg 125:1223–1232. https://doi.org/10.1213/ANE.0000000000002369 CrossRefPubMed

32.

Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP (2003) Renal dysfunction and serious infections after open-heart surgery. Kidney Int 64(1):239–246. https://doi.org/10.1046/j.1523-1755.2003.00040.x CrossRefPubMed

33.

Kelly KJ (2003) Distant effects of experimental renal ischemia/reperfusion injury. J Am Soc Nephrol 14(6):1549–1558CrossRefPubMed

34.

Grams ME, Rabb H (2012) The distant organ effects of acute kidney injury. Kidney Int 81(10):942–948. https://doi.org/10.1038/ki.2011.241 CrossRefPubMed

35.

Mohmand H, Goldfarb S (2011) Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome. J Am Soc Nephrol 22(4):615–621. https://doi.org/10.1681/ASN.2010121222 CrossRefPubMed

36.

Coca SG, Singanamala S, Parikh CR (2012) Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 81(5):442–448. https://doi.org/10.1038/ki.2011.379 CrossRefPubMed

37.

Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, Collins AJ (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20(1):223–228. https://doi.org/10.1681/ASN.2007080837 CrossRefPubMedPubMedCentral

38.

Basile DP, Donohoe D, Roethe K, Osborn JL (2001) Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function. Am J Physiol Renal Physiol 281(5):F887–F899. https://doi.org/10.1152/ajprenal.2001.281.5.F887 CrossRefPubMed

39.

Basile DP, Bonventre JV, Mehta R, Nangaku M, Unwin R, Rosner MH, Kellum JA, Ronco C, Group AXW (2016) Progression after AKI: understanding maladaptive repair processes to predict and identify therapeutic treatments. J Am Soc Nephrol 27(3):687–697. https://doi.org/10.1681/ASN.2015030309 CrossRefPubMed

40.

Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, Layon AJ, Segal MS (2009) Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg 249(5):851–858. https://doi.org/10.1097/SLA.0b013e3181a40a0b CrossRefPubMed

Title: Acute kidney injury following implementation of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery
Authors: Joseph H. Marcotte
Kinjal Patel
Ronak Desai
John P. Gaughan
Deviney Rattigan
Kevin W. Cahill
Robin F. Irons
Justin Dy
Monika Dobrowolski
Helena McElhenney
Michael Kwiatt
Steven McClane
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 9/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3084-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute kidney injury following implementation of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2018

Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers

Correction to: Interstitial cells of Cajal increased in patients with rectal prolapse

The effect of gender on early colonic anastomotic wound healing

Impact of superimposed Clostridium difficile infection in Crohn’s or ulcerative colitis flares in the outpatient setting

Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care

The role of body composition in diverticular disease