Cargando…

Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis

BACKGROUND: The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery...

Descripción completa

Detalles Bibliográficos
Autores principales: Shim, Jung-Woo, Kim, Kyoung Rim, Jung, Yoonju, Park, Jaesik, Lee, Hyung Mook, Kim, Yong-Suk, Moon, Young Eun, Hong, Sang Hyun, Chae, Min Suk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164643/
https://www.ncbi.nlm.nih.gov/pubmed/32302336
http://dx.doi.org/10.1371/journal.pone.0231447
_version_ 1783523328875560960
author Shim, Jung-Woo
Kim, Kyoung Rim
Jung, Yoonju
Park, Jaesik
Lee, Hyung Mook
Kim, Yong-Suk
Moon, Young Eun
Hong, Sang Hyun
Chae, Min Suk
author_facet Shim, Jung-Woo
Kim, Kyoung Rim
Jung, Yoonju
Park, Jaesik
Lee, Hyung Mook
Kim, Yong-Suk
Moon, Young Eun
Hong, Sang Hyun
Chae, Min Suk
author_sort Shim, Jung-Woo
collection PubMed
description BACKGROUND: The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI. PATIENTS AND METHODS: From January 2017 to August 2019, a total of 453 patients underwent laparoscopic colorectal cancer resection with the ERAS protocol. Among them, 125 patients met the criteria for oliguria and were propensity score (PS) matched to 328 patients without intraoperative oliguria. After PS matching had been performed, 125 patients from each group were selected and the incidences of AKI were compared between the two groups. Postoperative kidney function and surgical outcomes were also evaluated. RESULTS: The incidence of AKI was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2%, respectively, P = 0.002). Also, the eGFR reduction on postoperative day 0 was significantly greater in the intraoperative oliguria than non-intraoperative oliguria group (−9.02 vs. −1.24 mL/min/1.73 m(2) respectively, P < 0.001). In addition, the surgical complication rate was higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (18.4% vs. 9.6%, respectively, P = 0.045). CONCLUSIONS: Despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI. Further studies regarding appropriate management of intraoperative oliguria in association with long-term prognosis are needed in the colorectal ERAS setting.
format Online
Article
Text
id pubmed-7164643
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-71646432020-04-22 Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis Shim, Jung-Woo Kim, Kyoung Rim Jung, Yoonju Park, Jaesik Lee, Hyung Mook Kim, Yong-Suk Moon, Young Eun Hong, Sang Hyun Chae, Min Suk PLoS One Research Article BACKGROUND: The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI. PATIENTS AND METHODS: From January 2017 to August 2019, a total of 453 patients underwent laparoscopic colorectal cancer resection with the ERAS protocol. Among them, 125 patients met the criteria for oliguria and were propensity score (PS) matched to 328 patients without intraoperative oliguria. After PS matching had been performed, 125 patients from each group were selected and the incidences of AKI were compared between the two groups. Postoperative kidney function and surgical outcomes were also evaluated. RESULTS: The incidence of AKI was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2%, respectively, P = 0.002). Also, the eGFR reduction on postoperative day 0 was significantly greater in the intraoperative oliguria than non-intraoperative oliguria group (−9.02 vs. −1.24 mL/min/1.73 m(2) respectively, P < 0.001). In addition, the surgical complication rate was higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (18.4% vs. 9.6%, respectively, P = 0.045). CONCLUSIONS: Despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI. Further studies regarding appropriate management of intraoperative oliguria in association with long-term prognosis are needed in the colorectal ERAS setting. Public Library of Science 2020-04-17 /pmc/articles/PMC7164643/ /pubmed/32302336 http://dx.doi.org/10.1371/journal.pone.0231447 Text en © 2020 Shim et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shim, Jung-Woo
Kim, Kyoung Rim
Jung, Yoonju
Park, Jaesik
Lee, Hyung Mook
Kim, Yong-Suk
Moon, Young Eun
Hong, Sang Hyun
Chae, Min Suk
Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title_full Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title_fullStr Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title_full_unstemmed Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title_short Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis
title_sort role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: a propensity score matching analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164643/
https://www.ncbi.nlm.nih.gov/pubmed/32302336
http://dx.doi.org/10.1371/journal.pone.0231447
work_keys_str_mv AT shimjungwoo roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT kimkyoungrim roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT jungyoonju roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT parkjaesik roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT leehyungmook roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT kimyongsuk roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT moonyoungeun roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT hongsanghyun roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis
AT chaeminsuk roleofintraoperativeoliguriainriskstratificationforpostoperativeacutekidneyinjuryinpatientsundergoingcolorectalsurgerywithanenhancedrecoveryprotocolapropensityscorematchinganalysis