Abstract
Postoperative acute kidney injury (AKI) is a serious complication that increases patient morbidity and mortality. However, few studies have evaluated the effect of laparoscopic surgery on postoperative AKI. This study compared the incidence of postoperative AKI between laparoscopic and open surgery in patients with colorectal cancer. This study retrospectively analyzed 3637 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into laparoscopic (n = 987) and open (n = 2650) surgery groups. We performed multivariable regression analysis to assess the risk factors for AKI and propensity score matching analysis to compare the incidence of AKI between the two groups. We also assessed postoperative intensive care unit (ICU) admission, complications, hospital stay, and 1-year mortality. We observed no significant differences in the incidence of postoperative AKI between the two groups before (8.8% vs. 9.1%, p = 0.406) and after (8.8% vs. 7.7%, p = 0.406) matching. Laparoscopic surgery was not associated with AKI even after adjusting for intraoperative variables (adjusted odds ratio (OR): 1.17, 95% confidence interval (CI): 0.84–1.62, p = 0.355). Body mass index, diabetes mellitus, hypertension, and albumin were risk factors for AKI. ICU admission (0.6% vs. 2.5%, p = 0.001), complications (0.2% vs. 1.5%, p = 0.002), hospital stay (6.89 days vs. 8.61 days, p < 0.001), and 1-year mortality (0.1% vs. 0.9%, p = 0.021) were significantly better in the laparoscopic than in the open group. The incidence of postoperative AKI did not differ significantly between laparoscopic and open surgery. However, considering its better surgical outcomes, laparoscopic surgery may be recommended for patients with colorectal cancer.
Highlights
Acute kidney injury (AKI) is a common postoperative complication that is defined as an abrupt decrease in the kidney function, including decreased urine output, and elevated serum creatinine levels [1]
Postoperative AKI increases the risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD) [3]
The primary outcomes were the results of the comparisons of the incidence of AKI between the two groups and the analysis of the risk factors associated with postoperative AKI
Summary
Acute kidney injury (AKI) is a common postoperative complication that is defined as an abrupt decrease in the kidney function, including decreased urine output, and elevated serum creatinine levels [1]. AKI significantly increases morbidity and mortality, as well as hospital costs in surgical patients [2]. Laparoscopic surgery is well known for resulting in minimal trauma, less bleeding, and more stable hemodynamics in surgical patients [7,8]; these factors might reduce postoperative acute renal injury [9]. Few studies have assessed the effect of laparoscopic CRC surgery on postoperative AKI. We compared the incidence of postoperative AKI between open and laparoscopic surgery in patients with CRC. We assessed postoperative ICU admission and complications, hospital stay, and 1-year mortality. We retrospectively reviewed all patients diagnosed with CRC based on the International Classification of Diseases, tenth revision (ICD-10), and who underwent open or laparoscopic surgery between June 2008 and February 2012. The exclusion criteria were as follows: patients with severe cardiopulmonary or chronic kidney disease before admission; patients who had already received kidney replacement therapy; patients who had received interventions in the urethra, ureter, or kidneys during surgery; patients who underwent emergency surgery; patients with conversion from laparoscopic to laparotomy during surgery; and patients with incomplete data or missing serum creatinine values
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