PD60-07 ACUTE KIDNEY INJURY WITH ENHANCED RECOVERY AFTER SURGERY PROTOCOL IN RADICAL CYSTECTOMY SURGERY: A PROPENSITY SCORE-MATCHED STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive VI (PD60)1 Apr 2020PD60-07 ACUTE KIDNEY INJURY WITH ENHANCED RECOVERY AFTER SURGERY PROTOCOL IN RADICAL CYSTECTOMY SURGERY: A PROPENSITY SCORE-MATCHED STUDY Peter Hanna*, Matthew Peterson, Arveen Kalapera, Subodh Regmi, Kalyana Srujana, Joseph Zabell, Darrel Randle, Badrinath Konety, Joyce Wahr, and Christopher Weight Peter Hanna*Peter Hanna* More articles by this author , Matthew PetersonMatthew Peterson More articles by this author , Arveen KalaperaArveen Kalapera More articles by this author , Subodh RegmiSubodh Regmi More articles by this author , Kalyana SrujanaKalyana Srujana More articles by this author , Joseph ZabellJoseph Zabell More articles by this author , Darrel RandleDarrel Randle More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , Joyce WahrJoyce Wahr More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000977.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fluid management within enhanced recovery after surgery is a crucial element aiming to maintain optimum fluid balance through the perioperative period. We assessed the effect of enhanced recovery after surgery (ERAS) protocol mandated intraoperative fluid restriction on kidney function and incidence of postoperative acute kidney injury (AKI). METHODS: A total of 115 radical cystectomy patients managed by ERAS protocol were compared to a propensity- matched group of patients undergoing radical cystectomy without being subject to the ERAS protocol. Average creatinine, blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) were recorded preoperatively and on. Incidence of AKI was assessed on subset of patients (99 patients, [86.1 %] in pre-ERAS group and 97 patients [84.3 %] in ERAS cohorts) whom had normal preoperative baseline serum creatinine according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Length of hospital stay (LOS), time of return of bowel function, incidence of postoperative complications and readmission status were also recorded. RESULTS: Increased rate of postoperative AKI was observed in patients undergoing cystectomy using the ERAS protocol mandated fluid restrictions (15.4 % vs 6 %, OR = 2.72, p= 0.039). For ERAS patients, average creatinine was significantly changed from baseline creatinine on postoperative day 1 (POD 1) (p=0.0001), POD 3 (p=0.011) and on discharge (p=0.03). Average BUN was significantly changed compared to preoperative baseline BUN on POD 1 (p=002), POD 2 (p= 0.006), POD 3 (p < 0.0001), on discharge (p < 0.0001) and on 3 months follow up (p=<0.0001). However, average postoperative eGFR (POD 2, 3, on discharge and 3 months follow up) wasn’t significantly changed from baseline eGFR except on POD 1 (p=0.0001). ERAS protocol implementation was associated with significant reduction of GIT recovery time (p=0.002), but it wasn’t significantly associated with decrease of LOS (p= 0.185) or 30 days readmission rate (p= 0.28). CONCLUSIONS: Despite the proven benefits of the Enhanced Recovery After Surgery (ERAS) protocols, careful monitoring and readjustment of fluids during protocol implementation are recommended to reduce the likelihood of acute kidney injury. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1276-e1277 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Hanna* More articles by this author Matthew Peterson More articles by this author Arveen Kalapera More articles by this author Subodh Regmi More articles by this author Kalyana Srujana More articles by this author Joseph Zabell More articles by this author Darrel Randle More articles by this author Badrinath Konety More articles by this author Joyce Wahr More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...