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World Journal of Surgery
Published in: World Journal of Surgery 5/2019

01-05-2019 | Acute Kidney Injury | Original Scientific Report

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

Authors: Fabian Grass, Jenna K. Lovely, Jacopo Crippa, Kellie L. Mathis, Martin Hübner, David W. Larson

Published in: World Journal of Surgery | Issue 5/2019

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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.
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Metadata
Title
Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory
Authors
Fabian Grass
Jenna K. Lovely
Jacopo Crippa
Kellie L. Mathis
Martin Hübner
David W. Larson
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 5/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-04923-1

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