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Acute kidney injury following implementation of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery

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Abstract

Purpose

Fluid management within Enhanced Recovery After Surgery (ERAS) protocols is designed to maintain a euvolemic state avoiding the negative sequelae of hypervolemia or hypovolemia. We sought to determine the effect of a recent ERAS protocol implementation on kidney function and on the incidence of postoperative acute kidney injury (AKI).

Methods

A total of 132 elective colorectal resections performed using our ERAS protocol were compared to a propensity-matched group prior to ERAS implementation. Fluid balance, urine output, creatinine, and blood urea nitrogen (BUN) were recorded for all patients, and the incidence of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results

Implementation of our ERAS protocol decreased average postoperative length of hospital stay (5.5 vs 7.7 days, p < 0.0001) and time to return of bowel function (2.5 vs 4.1 days, p < 0.0001). The rate of postoperative AKI increased following implementation of the protocol (11.4 vs 2.3%, p < 0.0001). However, by the time of discharge, the average creatinine of ERAS patients who had experienced AKI had returned to their preoperative baseline values (p = 0.9037). Significant univariate predictors of AKI in ERAS patients were longer operative times (p < 0.01) and the diagnosis of diverticulitis (p < 0.01). Within our ERAS patients, AKI was associated with a prolonged postoperative length of hospital stay (p < 0.01).

Conclusions

Despite the proven benefits of the Enhanced Recovery After Surgery (ERAS) protocols, care should be taken during protocol implementation to monitor for and to prevent acute kidney injury.

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Authors and Affiliations

  1. The Department of Surgery, Cooper University Hospital, Suite 403, 3 Cooper Plaza, Camden, NJ, 08103, USA

    Joseph H. Marcotte, John P. Gaughan, Deviney Rattigan, Kevin W. Cahill, Robin F. Irons, Monika Dobrowolski, Helena McElhenney, Michael Kwiatt & Steven McClane

  2. The Department of Anesthesiology, Cooper University Hospital, Camden, NJ, USA

    Kinjal Patel, Ronak Desai & Justin Dy

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  1. Joseph H. Marcotte
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  2. Kinjal Patel
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Correspondence to Joseph H. Marcotte.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Marcotte, J.H., Patel, K., Desai, R. et al. Acute kidney injury following implementation of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery. Int J Colorectal Dis 33, 1259–1267 (2018). https://doi.org/10.1007/s00384-018-3084-9

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