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Risk factors for acute kidney injury in an enhanced recovery pathway for colorectal surgery

Surgery Today volume 51, pages 537–544 (2021)Cite this article

Abstract

Purposes

Enhanced recovery pathways (ERPs) have been disseminated worldwide to improve the perioperative patient outcomes while lowering direct healthcare costs. Recent evidence has revealed a potential association between ERPs for colorectal surgery and acute kidney injury (AKI). We, therefore, sought to identify the risk factors associated with postoperative AKI among patients in an ERP for colorectal surgery.

Methods

We analyzed the data resulting from a large multicenter, prospective cohort study of patients in an ERP for colorectal surgery. A multivariable analysis was performed to identify factors independently associated with postoperative AKI. The receiver operating characteristic (ROC) curves and contour representations were plotted for the diagnostic prediction analysis.

Results

Among those patients included in the analysis (n = 1652), the overall incidence of postoperative AKI was 7.7% (95% CI 6.5–9.1%). After adjustment, the independent risk factors for AKI included age > 60 (OR 1.03, 95% CI 1.01–1.05), male gender (OR 2.33, 95% CI 1.36–4.02), ASA III-IV (OR 2.43, 95% CI 1.39–4.26), CKD (OR 2.45, 95% CI 1.42–4.23), open surgical approach (OR 2.62, 95% CI 1.63–4.21) and serum albumin < 3.5 g/dL (OR 1.68, 95% CI 1.02–2.79). An ROC analysis revealed that the composite of albumin, creatinine and age was a strong predictor of postoperative AKI [area under the curve (AUC) 0.756; 95% CI 0.705–0.808].

Conclusion

Postoperative AKI is common in the setting of ERPs for colorectal surgery and it is associated with a poor clinical outcome. Of those characteristics associated with postoperative AKI, one modifiable factor is a low preoperative albumin level. Screening for malnourished patients or optimizing the nutritional status may be a useful preoperative intervention to prevent postoperative AKI and associated complications.

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Funding

Support was provided solely from institutional sources.

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Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Andrés Zorrilla-Vaca & Gabriel E. Mena

  2. Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain

    Javier Ripolles-Melchor

  3. Department of Anesthesia, Hospital Juan Ramon Jimenez, Huelva, Spain

    Juan Victor Lorente

  4. Department of General Surgery, Lozano Blesa University Hospital Zaragoza Spain, Zaragoza, Spain

    Juan José M. Ramirez-Rodriguez

  5. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael C. Grant

Authors
  1. Andrés Zorrilla-Vaca
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  2. Gabriel E. Mena
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  3. Javier Ripolles-Melchor
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  4. Juan Victor Lorente
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  5. Juan José M. Ramirez-Rodriguez
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  6. Michael C. Grant
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Contributions

Design of the study, analyze data, drafting the manuscript, interpretation of data.

Corresponding author

Correspondence to Andrés Zorrilla-Vaca.

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Zorrilla-Vaca, A., Mena, G.E., Ripolles-Melchor, J. et al. Risk factors for acute kidney injury in an enhanced recovery pathway for colorectal surgery. Surg Today 51, 537–544 (2021). https://doi.org/10.1007/s00595-020-02107-2

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  • DOI: https://doi.org/10.1007/s00595-020-02107-2

Keywords

  • Acute kidney injury
  • Enhanced recovery pathways
  • Albumin
  • Perioperative medicine
  • Colorectal surgery