Impact of intraoperative zero-balance fluid therapy on the occurrence of acute kidney injury in patients who had undergone colorectal cancer resection within an enhanced recovery after surgery protocol: a propensity score matching analysis

Shim, Jung Ho; Kwak, Jueun; Roh, Kyungmoon; Ro, Hojun; Lee, Chul Seung; Han, Sim-Hee; Lee, Yoon Suk; Lee, In Kyu; Park, Jaesik; Lee, Hyung Mook; Chae, Min Suk; Lee, Hae-Jin; Hong, Sang Hyun

doi:10.1007/s00384-020-03616-9

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…Of the included 19 studies, all of studies showed the rate of AKI after surgery, six of these studies [ 11 – 13 , 27 , 30 , 32 ] also reported postoperative complications other than AKI, only 3 studies [ 16 , 33 , 34 ] were not reported a difference in length of stay (LOS) in the ERAS vs. standard group. Rate of 30-day readmission or reoperation reported in 13 studies [ 9 – 12 , 15 , 17 , 25 – 30 , 32 ] and mortality in 8 studies [ 11 , 12 , 14 , 15 , 25 , 26 , 30 , 32 ]. 11 studies adopted the fluid management mode of goal-directed fluid therapy (GDFT) [ 10 – 17 , 27 , 29 , 30 ], 6 studies used restrictive fluid management intraoperatively [ 9 , 25 , 26 , 28 , 33 , 34 ], and the remaining 2 studies [ 31 , 32 ] did not elaborate the fluid management mode.…”

Section: Resultsmentioning

confidence: 99%

“…11 studies adopted the fluid management mode of goal-directed fluid therapy (GDFT) [ 10 – 17 , 27 , 29 , 30 ], 6 studies used restrictive fluid management intraoperatively [ 9 , 25 , 26 , 28 , 33 , 34 ], and the remaining 2 studies [ 31 , 32 ] did not elaborate the fluid management mode. Ten studies [ 9 , 10 , 12 – 15 , 29 , 31 , 33 , 34 ] adopted the KDIGO criteria to evaluate AKI, which 1.5 times the preoperative baseline value within 30 days after operation based on the latest clinical guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 35 ]. Four studies [ 11 , 16 , 17 , 30 ] adopted RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease classification) [ 36 ], EPCO (European Perioperative Clinical Outcome definitions) [ 37 ], and NSQIP (National Surgical Quality Improvement Program) [ 38 ] criteria to define the occurrence of AKI respectively and the remaining 5 studies [ 25 – 28 , 32 ] did not mention the evaluation criteria for AKI.…”

Section: Resultsmentioning

confidence: 99%

“…Our initial search yielded 7,441 potentially relevant cohort studies on postoperative complications including AKI occurring with ERAS versus conventional therapy in patients who underwent surgery. After screening and reviewing, 19 studies [9][10][11][12][13][14][15][16][17][25][26][27][28][29][30][31][32][33][34] met our inclusion criteria. Of the nineteen, seventeen were retrospective and two were prospective cohort studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Relatively balanced fluid management, flexible use of vasoactive drugs, multimodal analgesia containing non-steroidal anti-inflammatory drugs raise concerns that the use of ERAS may lead to an increased incidence of postoperative AKI [8]. Proven by studies that ERAS protocol exacerbates the risk of AKI development after colorectal surgery [9][10][11][12][13]. However, some scholars have objected that ERAS will not aggravate the occurrence of postoperative AKI [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Shen

Wang

et al. 2021

PLoS ONE

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Background Acute kidney injury (AKI) is a common postoperative complication with an incidence of nearly 15%. Relatively balanced fluid management, flexible use of vasoactive drugs, multimodal analgesia containing non-steroidal anti-inflammatory drugs are fundamental to ERAS protocols. However, these basic tenants may lead to an increased incidence of postoperative AKI. Methods A search was done in the PubMed, Embase, Cochrane Library and reference lists to identify relevant studies from inception until May 2020 to be included in this study. Effects were summarized using pooled risk ratios (RRs), mean differences (MDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. Results A systematic review of nineteen cohort studies covering 17,205 patients, comparing impact of ERAS with conventional care on postoperative AKI was performed. Notably, the ERAS regimen did not increase the incidence of postoperative AKI compared with standard care (RR: 1.21; 95% CI: 0.96 to 1.52; I2 = 53%). Both goal-directed fluid therapy (RR: 1.26; 95% CI: 0.99–1.61; I2 = 55%) and restrictive fluid management (RR: 1.06; 95% CI: 0.57–1.98; I2 = 60%) had no significant effect on the incidence of postoperative AKI. There was no significant statistical difference between different AKI diagnostic criteria (P = 0.43; I2 = 0%). ERAS group had significantly shorter hospital stay (MD: −1.54; 95% CI: −1.91 to −1.17; I2 = 66%). There was no statistical difference in 30-day readmission rate (RR: 0.98; 95% CI: 0.80 to 1.20; I2 = 42%), 30-day reoperation rate (RR: 0.98; 95% CI: 0.71 to 1.34; I2 = 42%) and mortality (RR: 0.81; 95% CI: 0.59 to 1.11; I2 = 0%) between the two groups. Conclusions This meta-analysis suggests that ERAS protocols do not increase readmission or reoperation rates and mortality while significantly reducing LOS. Most importantly, the ERAS protocol was shown to have no promoting effect on the incidence of postoperative AKI. Even GDFT and restrictive fluid management cannot avoid the occurrence of postoperative AKI, and the ERAS protocol is still worth recommending and its safety is further confirmed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Shen

Wang

et al. 2021

PLoS ONE

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“…RFT may induce hypotension and organ hypoperfusion, they are important risk factors of postoperative AKI. In colorectal surgery, ERAS program with zero-balance uid therapy was associated with higher incidence of AKI [11]. AKI should be concerned when ERAS program was implemented.…”

Section: Introductionmentioning

confidence: 98%

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

Wang

et al. 2022

Preprint

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Background: To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods: Patients, more than 60-year-old, undergoing thoracoscopic pulmonary resection for non small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI) and mean arterial pressure (MAP), maintained the SVV<13%, CI>2.5L/min/m2, and MAP>65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP>65 mmHg. The incidence of postoperative acute kidney injury (AKI), pulmonary and cardiac complications were compared. Results: 276 patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were larger, the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P=0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9±25.2 μmol/L vs 97.1±17.6 μmol/L; P=0.048). Conclusions: Compared to ERAS program with RFT, ERAS program with GDFT has slight beneficial effect on postoperative renal function in elderly patients undergoing thoracoscopic pulmonary resection. Trial registration: Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

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Male Patients may be More Vulnerable to Acute Kidney Injury After Colorectal Surgery in an Enhanced Recovery Program: A Propensity Score Matching Analysis

Shim

Lee

et al. 2021

World j. surg.

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Background Although many reports have shown that enhanced recovery after surgery (ERAS) programs improve the perioperative outcomes of patients undergoing colorectal surgery, the prevalence of early acute kidney injury (AKI) after surgery in such patients requires attention. Protective roles of the female sex in terms of chronic kidney disease and progression of ischemic renal injury have been described in many studies. We thus explored whether a sex difference was evident in terms of postoperative AKI in a colorectal ERAS setting. Methods From January 2017 to August 2019, 453 patients underwent laparoscopic colorectal cancer resection in an enhanced recovery program. Of these, 217 female patients were propensity score (PS)-matched with 236 male patients. Then, 215 patients of either sex were compared in terms of postoperative renal function and complications. Results Among the PS-matched patients, the incidence of AKI was significantly higher in male than female patients (24.2% vs. 9.8%, P \ 0.001). Male patients also exhibited a greater reduction in the postoperative estimated glomerular filtration rate, compared with female patients. The male sex was associated with an approximately threefold increase in the risk of AKI. The rate of surgical complications was significantly higher in male than female patients. Conclusions Caution must be taken to prevent postoperative AKI in patients (particularly males) participating in colorectal ERAS programs. The mechanism underlying the sex difference remains unclear. Additional studies are required to determine whether male patients require perioperative management that differs from that of females, to prevent postoperative AKI.

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Impact of intraoperative zero-balance fluid therapy on the occurrence of acute kidney injury in patients who had undergone colorectal cancer resection within an enhanced recovery after surgery protocol: a propensity score matching analysis

Cited by 11 publications

References 35 publications

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

Male Patients may be More Vulnerable to Acute Kidney Injury After Colorectal Surgery in an Enhanced Recovery Program: A Propensity Score Matching Analysis

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