Caution

Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols

Crystal P. Koerner, Alexandra G. Lopez-Aguiar, Mohammad Zaidi, Shelby Speegle, Glen C Balch, Virginia O. Shaffer, Charles A. Staley, Jahnavi Srinivasan, Shishir K. Maithel, Patrick S. Sullivan

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)156-161
Number of pages6
JournalAmerican Surgeon
Volume85
Issue number2
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Acute Kidney Injury
Length of Stay
Colorectal Surgery
Morbidity
Mortality
Incidence
Creatinine
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Koerner, C. P., Lopez-Aguiar, A. G., Zaidi, M., Speegle, S., Balch, G. C., Shaffer, V. O., ... Sullivan, P. S. (2019). Caution: Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols. American Surgeon, 85(2), 156-161.

Caution : Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols. / Koerner, Crystal P.; Lopez-Aguiar, Alexandra G.; Zaidi, Mohammad; Speegle, Shelby; Balch, Glen C; Shaffer, Virginia O.; Staley, Charles A.; Srinivasan, Jahnavi; Maithel, Shishir K.; Sullivan, Patrick S.

In: American Surgeon, Vol. 85, No. 2, 01.01.2019, p. 156-161.

Research output: Contribution to journalArticle

Koerner, CP, Lopez-Aguiar, AG, Zaidi, M, Speegle, S, Balch, GC, Shaffer, VO, Staley, CA, Srinivasan, J, Maithel, SK & Sullivan, PS 2019, 'Caution: Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols', American Surgeon, vol. 85, no. 2, pp. 156-161.
Koerner CP, Lopez-Aguiar AG, Zaidi M, Speegle S, Balch GC, Shaffer VO et al. Caution: Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols. American Surgeon. 2019 Jan 1;85(2):156-161.
Koerner, Crystal P. ; Lopez-Aguiar, Alexandra G. ; Zaidi, Mohammad ; Speegle, Shelby ; Balch, Glen C ; Shaffer, Virginia O. ; Staley, Charles A. ; Srinivasan, Jahnavi ; Maithel, Shishir K. ; Sullivan, Patrick S. / Caution : Increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols. In: American Surgeon. 2019 ; Vol. 85, No. 2. pp. 156-161.
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abstract = "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.",
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