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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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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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Data availability

The study data is not available. Code availability the code is not available.

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Funding

The authors received the financial support of the Catholic Medical Center Research Foundation made in the program year of 2019.

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Authors and Affiliations

  1. Department of Anaesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jung-Woo Shim, Jaesik Park, Hyung Mook Lee, Min Suk Chae, Hae-Jin Lee & Sang Hyun Hong

  2. Department of Anaesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jueun Kwak

  3. Department of Anaesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Kyungmoon Roh

  4. Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hojun Ro & In Kyu Lee

  5. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Chul Seung Lee, Seung Rim Han & Yoon Suk Lee

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  1. Jung-Woo Shim
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Contributions

Conceptualisation, J.S. and S.H.H.; data curation, J.S., J.K., K.R., and H.R.; formal analysis, J.S., J.K., K.R., H.R., C.S.L., S.R.H., Y.S.L., I.K.L., J.P., H.M.L., M.S.C., H.L., and S.H.H.; funding acquisition, S.H.H.; investigation, J.S., J.K., K.R., H.R., C.S.L., S.R.H., Y.S.L., I.K.L., J.P., H.M.L., M.S.C., H.L., and S.H.H.; methodology, J.S. and S.H.H.; resources, J.S.; software, J.S.; supervision, J.S. and S.H.H.; validation, J.S. and S.H.H.; visualisation, J.S.; writing—original draft, J.S.; writing—review and editing, J.S. and S.H.H.

Corresponding author

Correspondence to Sang Hyun Hong.

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The authors declare that they have no conflicts of interest.

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board at the College of Medicine. This study was approved by the Institutional Review Board and Ethics Committee of Seoul St. Mary’s Hospital (approval number: KC19RESI0598).

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Informed consent from patients to be included in this study was waived according to the policy of our IRB.

Consent for publication

Informed consent from patients to be included in this study was waived according to the policy of our IRB.

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Shim, JW., Kwak, J., Roh, K. et al. 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. Int J Colorectal Dis 35, 1537–1548 (2020). https://doi.org/10.1007/s00384-020-03616-9

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