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

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 discoura...

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Bibliographic Details
Published in:PloS one 2020-04, Vol.15 (4), p.e0231447-e0231447
Main Authors: 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
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesiology
Biology and Life Sciences
Blood pressure
Cancer
Colorectal cancer
Colorectal carcinoma
Drug dosages
Epidermal growth factor receptors
Hospitals
Kidneys
Laparoscopy
Matching
Medical personnel
Medical schools
Medicine
Medicine and Health Sciences
Pain
Patients
Recovery
Studies
Surgeons
Surgery
Urine
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Summary: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. 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. 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 m2 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). 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0231447