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 JW, Kim KR, Jung Y, Park J, Lee HM, Kim YS, Moon YE, Hong SH, Chae MS, South Korea.

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.

PLoS One. 2020 Apr 17;15(4): doi: 10.1371/journal.pone.0231447.  PMID: 32302336

What is already known:

It is known that acute kidney injury (AKI) is a common complication following major abdominal surgery and is associated with increased length of hospital stay, the progression of chronic kidney disease (CKD), and increased long-term mortality.

The ERAS protocol promotes several measures which aim to maintain near euvolaemia such as preoperative carbohydrate loading, avoidance of bowel preparation, minimisation of fasting times, minimally invasive surgery, and early resumption of oral fluid therapy.

High compliance to those items in conjunction with recommendation of a balanced perioperative intravenous fluid regimen is proposed to limit complications such as paralytic ileus and sequelae from fluid overload, while failure to implement those measures may predispose patients to intravascular volume depletion and hence increase their risk of AKI.

In the last three years, three studies have published results indicating an increase in AKI after implementing an ERAS-like enhance recovery programs for colorectal cancer surgery. The current study is the most recent one, published in 2020.

What this paper adds:

In patients undergoing laparoscopic colorectal cancer resection within an ERAS protocol, 125 out of 453 (28%) met the criteria for oliguria and were propensity score matched to 328 patients without intraoperative oliguria. The incidence of AKI and rate of postoperative complications was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2% and 18.4% vs 9.6%, respectively).

The authors conclude that despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI.

Additional comment:

The outcomes from the current study and the two previously published studies high lightening the risk of AKI are discussed in the recently published “Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery”, Drakeford at al, also commented on this website.