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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Acute Kidney Injury
Creatinine
Colorectal Surgery
Minimally Invasive Surgical Procedures
Chronic Renal Insufficiency
Chronic Kidney Failure
Weight Gain
Dialysis
Diabetes Mellitus
Logistic Models
Regression Analysis
Databases
Kidney
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

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Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway : Uncommon and Transitory. / Grass, Fabian; Lovely, Jenna K.; Crippa, Jacopo; Mathis, Kellie L.; Hübner, Martin; Larson, David.

In: World Journal of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Grass, Fabian ; Lovely, Jenna K. ; Crippa, Jacopo ; Mathis, Kellie L. ; Hübner, Martin ; Larson, David. / Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway : Uncommon and Transitory. In: World Journal of Surgery. 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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