Abstract
BackgroundWhile enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied.MethodsPatients undergoing major colorectal surgery under ERP (February 2010 to March 2013) were compared with a traditional care control group (October 2004 October 2007) at a single institution. Multivariable regression models examined the association of ERP with postoperative creatinine changes and incidence of postoperative acute kidney dysfunction (based on the Risk, Injury, Failure, Loss, and End-stage renal disease criteria).ResultsIncluded were 1054 patients: 590 patients underwent surgery with ERP and 464 patients without ERP. Patient demographics were not significantly different. Higher rates of neoplastic and inflammatory bowel disease surgical indications were found in the ERP group (81 vs. 74%, p = 0.045). Patients in the ERP group had more comorbidities (ASA ≥ 3) (62 vs. 40%, p < 0.001). In unadjusted analysis, postoperative creatinine increase was slightly higher in the ERP group compared with control (median 0.1 vs. 0 mg/dL, p < 0.001), but levels of postoperative acute kidney injury were similar in both groups (p = 0.998). After adjustment with multivariable regression, postoperative changes in creatinine were similar in ERP vs. control (p = 0.25).ConclusionsERP in colorectal surgery is not associated with a clinically significant increase in postoperative creatinine or incidence of postoperative kidney injury. Our results support the safety of ERPs in colorectal surgery and may promote expanding implementation of these protocols.Trial registrationNot applicable, prospective data collection and retrospective chart review only.
Highlights
While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied
Patient and treatment characteristics A total of 1054 patients were included, 590 (56%) of whom were treated in the ERP group and 464 (44%) patients were in the control group
American Society of Anesthesiologists (ASA) class tended to be higher in the ERP group
Summary
While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. Enhanced recovery protocols (ERPs) are multimodal approaches focusing on improving patient surgical outcomes through preoperative optimization and emphasis on standardized evidence-based interventions in perioperative patient care. A growing body of evidence suggests that ERPs significantly reduce the incidence of perioperative complications, length of hospitalization, and health care costs for patients undergoing colorectal surgery (Miller et al, 2014; Zhuang et al, 2013; Lv, 2012). The etiology of AKI following surgery is multifactorial, it has been traditionally thought that liberal fluid administration may be beneficial in the perioperative period, when patients are predisposed to reductions in renal blood flow (Fearon et al, 2005; Lyon et al, 2012). Permissive oliguria is tolerated and is not necessarily treated with fluid boluses in the absence of other indicators of hypovolemia
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