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

被引：14

作者：

Shim, Jung-Woo ^{[1
]}

Kim, Kyoung Rim ^{[2
]}

Jung, Yoonju ^{[3
]}

Park, Jaesik ^{[1
]}

Lee, Hyung Mook ^{[1
]}

Kim, Yong-Suk ^{[1
]}

Moon, Young Eun ^{[1
]}

Hong, Sang Hyun ^{[1
]}

Chae, Min Suk ^{[1
]}

机构：

[1] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Anesthesiol & Pain Med, Seoul, South Korea

[2] Catholic Univ Korea, Bucheon St Marys Hosp, Dept Anesthesiol & Pain Med, Seoul, South Korea

[3] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Surg, Seoul, South Korea

来源：

PLOS ONE | 2020年 / 15卷 / 04期

关键词：

CLASICC TRIAL; GUIDELINES; COLON; MANAGEMENT; OUTCOMES; SOCIETY; CARE;

D O I：

10.1371/journal.pone.0231447

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

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.

引用

页数：15

共 42 条

[1] The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery - A prospective cohort study within an ERAS protocol [J].