Dataset Information

Acute Kidney Injury in the Age of Enhanced Recovery Protocols.

ABSTRACT:

Background

Acute kidney injury is a prevalent complication after abdominal surgery. With increasing adoption of enhanced recovery protocols, concern exists for concomitant increase in acute kidney injury.

Objective

This study evaluated effects of enhanced recovery on acute kidney injury through identification of risk factors.

Design

This was a retrospective cohort study comparing acute kidney injury rates before and after implementation of enhanced recovery protocol.

Settings

The study was conducted at a large academic medical center.

Patients

All of the patients undergoing elective colorectal surgery between 2010 and 2016, excluding patients with stage 5 chronic kidney disease, were included.

Main outcome measures

Patients before and after enhanced recovery implementation were compared, with rate of acute kidney injury as the primary outcome. Acute kidney injury was defined as a rise in serum creatinine ≥1.5 times baseline within 30 days of surgery. Multivariable logistic regression identified risk factors for acute kidney injury.

Results

A total of 900 cases were identified, including 461 before and 439 after enhanced recovery; 114 cases were complicated by acute kidney injury, including 11.93% of patients before and 13.44% after implementation of enhanced recovery (p = 0.50). Five patients required hemodialysis, with 2 cases after protocol implementation. Multivariable logistic regression identified hypertension, functional status, ureteral stents, nonsteroidal anti-inflammatory drugs, operative time >200 minutes, and increased intravenous fluid administration on postoperative day 1 as predictors of acute kidney injury. Laparoscopic surgery decreased the risk of acute kidney injury. The enhanced recovery protocol was not independently associated with acute kidney injury.

Limitations

The study was limited by its retrospective and nonrandomized before-and-after design.

Conclusions

No difference in rates of acute kidney injury was detected before and after implementation of a colorectal enhanced recovery protocol. Independent predictors of acute kidney injury were identified and could be used to alter the protocol in high-risk patients. Future study is needed to determine whether protocol modifications will further decrease rates of acute kidney injury in this population. See Video Abstract at http://links.lww.com/DCR/A568.

SUBMITTER: Hassinger TE

PROVIDER: S-EPMC6042978 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Acute Kidney Injury in the Age of Enhanced Recovery Protocols.

Hassinger Taryn E TE Turrentine Florence E FE Thiele Robert H RH Sarosiek Bethany M BM McMurry Timothy L TL Friel Charles M CM Hedrick Traci L TL

Diseases of the colon and rectum 20180801 8

<h4>Background</h4>Acute kidney injury is a prevalent complication after abdominal surgery. With increasing adoption of enhanced recovery protocols, concern exists for concomitant increase in acute kidney injury.<h4>Objective</h4>This study evaluated effects of enhanced recovery on acute kidney injury through identification of risk factors.<h4>Design</h4>This was a retrospective cohort study comparing acute kidney injury rates before and after implementation of enhanced recovery protocol.<h4>Set ...[more]

PMID: 29994959

Similar Datasets

Project description:Background and objectivesAKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.Design, setting, participants, & measurementsUsing the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.ResultsMean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.ConclusionsKidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

Dataset Information

Acute Kidney Injury in the Age of Enhanced Recovery Protocols.

Background

Objective

Design

Settings

Patients

Main outcome measures

Results

Limitations

Conclusions

Publications

Acute Kidney Injury in the Age of Enhanced Recovery Protocols.

Similar Datasets

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