Impact of intraoperative zero-balance fluid therapy on the occurrence of acute kidney injury in patients who had undergone colorectal cancer resection within an enhanced recovery after surgery protocol: a propensity score matching analysis.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2020-08-01 Epub Date: 2020-05-08 DOI:10.1007/s00384-020-03616-9

Jung-Woo Shim, Jueun Kwak, Kyungmoon Roh, Hojun Ro, Chul Seung Lee, Seung Rim Han, Yoon Suk Lee, In Kyu Lee, Jaesik Park, Hyung Mook Lee, Min Suk Chae, Hae-Jin Lee, Sang Hyun Hong

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引用次数: 8

Abstract

Purpose: An enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection encourages perioperative euvolemic status, and zero-balance fluid therapy is recommended for low-risk patients. Recently, several studies have reported concerns of increased acute kidney injury (AKI) in patients within an ERAS protocol. In the present study, we investigated the impact of intraoperative zero-balance fluid therapy within an ERAS protocol on postoperative AKI.

Methods: Patients who underwent elective surgery for primary colorectal cancer were divided into zero-balance and non-zero-balance fluid therapy groups according to intraoperative fluid amount and balance. After propensity score (PS) matching, 210 patients from each group were selected. Incidences of AKI were compared between the two groups according to the Kidney Disease Improving Global Outcomes criteria. Postoperative kidney functions and surgical outcomes were also compared.

Results: AKI was significantly higher in the zero-balance fluid therapy group compared to the non-zero-balance fluid therapy group (21.4% vs. 13.8%, p = 0.040) in PS-matched patients. The decrease in the estimated glomerular filtration rate on the day of surgery was significantly higher in the zero-balance fluid therapy group (- 5.9 mL/min/1.73 m² vs. - 1.4 mL/min/1.73 m², p = 0.005). There were no differences in general morbidity or mortality rate, although surgery-related complications were more common in the zero-balance group.

Conclusions: Despite the proven benefits of zero-balance fluid therapy in colorectal ERAS protocols, care should be taken to monitor for postoperative AKI. Further studies regarding the clinical significance of postoperative AKI occurrence and optimised intraoperative fluid therapy are needed in a colorectal ERAS setting.

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术中零平衡液体治疗对结直肠癌切除术患者术后恢复增强的急性肾损伤发生的影响:倾向评分匹配分析

目的:结直肠癌切除术后增强恢复(ERAS)方案鼓励围手术期血容量状态，并推荐零平衡液体治疗低风险患者。最近，一些研究报道了ERAS方案中患者急性肾损伤(AKI)增加的担忧。在本研究中，我们研究了ERAS方案下术中零平衡液体治疗对术后AKI的影响。方法:根据术中液体量及平衡情况将择期大肠癌患者分为零平衡和非零平衡两组。经倾向评分(PS)匹配后，每组选取210例患者。根据肾脏疾病改善全球结局标准比较两组之间AKI的发生率。比较两组患者术后肾功能和手术效果。结果:在ps匹配的患者中，零平衡液体治疗组的AKI明显高于非零平衡液体治疗组(21.4%比13.8%，p = 0.040)。手术当日估计肾小球滤过率的下降在零平衡液治疗组明显更高(- 5.9 mL/min/1.73 m2 vs - 1.4 mL/min/1.73 m2, p = 0.005)。虽然手术相关并发症在零平衡组中更为常见，但总的发病率和死亡率没有差异。结论:尽管零平衡液体疗法在结直肠ERAS方案中已被证实有益处，但仍应注意监测术后AKI。需要进一步研究结直肠ERAS术后AKI发生的临床意义和优化术中液体治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.