MO320: Risk Factors and Outcomes Related to Acute Kidney Injury Among Enhanced Recovery After Surgery (ERAS) Colorectal Surgery

Abstract

Abstract BACKGROUND AND AIMS Enhanced recovery after surgery (ERAS) protocol is an evidence-based programme that englobe more restrictive fluid therapy to maintain euvolemia and the use of multimodal analgesia, which includes non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, it's pertinent to assess the risk and potential consequences of acute kidney injury (AKI) in the short and medium term. METHOD A descriptive and single-center retrospective study, which included 428 patients that were submitted to colon-rectal surgery according to ERAS protocol between November 2016 and May 2020. AKI was defined according to KDIGO criteria. RESULTS Data were collected from 428 patients. AKI occurred in 25.2% of patients (108), mostly KDIGO 1 (63.9%) and 6.5% required haemodialysis. The median time of follow-up was 25.6 months (IQ 15.6–38.8). Patient-related variables that positively influenced AKI were ASA Class III/IV [F (1, 426) = 23.2; P < .001], diabetes [F (1, 426) = 9.96; P = .002], severe heart disease [F (1, 426) = 7.12; P = .008], CKD [F (1, 425) = 11.58; P < .001], obesity [F (1, 423) = 14.21; P < .001] and use of ACE inhibitors/ARBs [F (1, 425) = 17.4; P < .001]. Preoperative and surgery-related variables that influenced AKI were preoperative haemoglobin [F (85, 338) = 1.36; P = .030], open approach [F (1, 424) = 21.5; P < .001], NSAIDs [F (1–426) = 5.77; P = .017], iodinated intravenous contrast exposure [F (1, 424) = 26.8; P < .001), postoperative support aminergic [F (1, 424) = 18.9; P < .001], surgery complications [F (1, 426) = 36.5; P < .001] and blood transfusion [F (1, 426) = 10.15; P = 0.002]. AKI group had a superior length of stay (9 versus 6 days; P < .001), ICU admission (31.5% versus 8.8%; P <.001), readmission at 30 days (12% versus 5.6%; P = .027) and mortality (23.1% versus 6.6%; P < .001). Kaplan–Meier analysis showed that the AKI group was associated with lower survival (log-rank test = 26.601; P < .001). We also found that the AKI group was associated with a greater reduction in GFR after 2 years (3.3 mL/min/1.73 m2 versus 1.8 mL/min/1.73 m2; P = .009). CONCLUSION AKI was frequent among ERAS patients and was associated with worst outcomes—higher costs (since it was associated to longer hospitalization, higher readmission at 30 days and ICU admission), higher risk of reduction in GFR in the first 2 years and higher mortality.