Impact of a kidney-adjusted ERAS
Humans
Male
Female
Nephrectomy
/ methods
Middle Aged
Aged
Enhanced Recovery After Surgery
Postoperative Complications
/ prevention & control
Prospective Studies
Kidney Neoplasms
/ surgery
Retrospective Studies
Length of Stay
Acute Kidney Injury
/ prevention & control
Treatment Outcome
Robotic Surgical Procedures
/ adverse effects
Renal Insufficiency, Chronic
Organ Sparing Treatments
/ methods
Enhanced recovery after surgery
Nephron sparing surgery
Partial nephrectomy
Renal cancer
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
23 Oct 2024
23 Oct 2024
Historique:
received:
05
09
2024
accepted:
15
10
2024
medline:
23
10
2024
pubmed:
23
10
2024
entrez:
23
10
2024
Statut:
epublish
Résumé
Evaluation of a kidney-adjusted enhanced recovery after surgery (ERAS The kERAS protocol is a multidimensional protocol focusing on optimized perioperative fluid and nutrition management as well as strict intraoperative and postoperative blood pressure limits. It was applied in a prospective cohort (n = 147) of patients undergoing open or robotic PN. Patients were analyzed for the development of acute postoperative renal failure (AKI), achievement of TRIFECTA criteria, upstaging or new onset of chronic kidney disease (CKD) and length of hospital stay (LOS) and compared to a retrospective cohort (n = 162) without application of the protocol. Cox regression analyses could not confirm a protective effect of kERAS on the development of AKI post-surgery. A positive effect was observed on TRIFECTA achievement (OR 2.2, 95% CI 1.0-4.5, p = 0.0374). Patients treated with the kERAS protocol showed less long-term CKD upstaging compared to those treated with the standard protocol (p = 0.0033). There was no significant effect on LOS and new onset of CKD. The implementation of a kERAS protocol can have a positive influence on long-term renal function in patients undergoing PN. It can be used safely without promoting AKI. Furthermore, it can be realized with a manageable amount of additional effort.
Identifiants
pubmed: 39441354
doi: 10.1007/s00423-024-03513-7
pii: 10.1007/s00423-024-03513-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
319Informations de copyright
© 2024. The Author(s).
Références
Fearon KC et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477
pubmed: 15896435
doi: 10.1016/j.clnu.2005.02.002
Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78(5):606–617
pubmed: 9175983
doi: 10.1093/bja/78.5.606
Fawcett J, W. and, Ljungqvist O (2017) Starvation, carbohydrate loading, and outcome after major surgery. BJA Educ 17(9):312–316
doi: 10.1093/bjaed/mkx015
Wuethrich PY, Burkhard FC (2015) New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery. Curr Urol Rep 16(4):17
pubmed: 25691437
doi: 10.1007/s11934-015-0490-1
Adding C et al (2015) Enhanced recovery protocols (ERP) in robotic cystectomy surgery. Review of current status and trends. Curr Urol Rep 16(5):32
pubmed: 25850413
doi: 10.1007/s11934-015-0497-7
Nicholson A et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188
pubmed: 24469618
doi: 10.1002/bjs.9394
Lemanu DP et al (2014) A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis 16(5):338–346
pubmed: 24283942
doi: 10.1111/codi.12505
Joliat G-R et al (2018) Beyond surgery: clinical and economic impact of enhanced recovery after surgery programs. BMC Health Serv Res 18(1):1008
pubmed: 30594252
pmcid: 6311010
doi: 10.1186/s12913-018-3824-0
Rodrigues Pessoa R et al (2020) Enhanced recovery after surgery review and urology applications in 2020. BJUI Compass 1(1):5–14
pubmed: 35474909
pmcid: 8988792
doi: 10.1002/bco2.9
Pang KH et al (2018) Prospective implementation of enhanced recovery after surgery protocols to Radical Cystectomy. Eur Urol 73(3):363–371
pubmed: 28801130
doi: 10.1016/j.eururo.2017.07.031
Vukovic N, Dinic L (2018) Enhanced recovery after surgery protocols in major urologic surgery. Front Med (Lausanne) 5:93
pubmed: 29686989
doi: 10.3389/fmed.2018.00093
Williams SB et al (2020) Reporting radical cystectomy outcomes following implementation of enhanced recovery after surgery protocols: a systematic review and individual Patient Data Meta-analysis. Eur Urol 78(5):719–730
pubmed: 32624275
doi: 10.1016/j.eururo.2020.06.039
Azhar RA et al (2016) Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and Research needs. Eur Urol 70(1):176–187
pubmed: 26970912
pmcid: 5514421
doi: 10.1016/j.eururo.2016.02.051
Wessels F et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World Journal of Urology
Cerantola Y et al (2013) Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced recovery after surgery (ERAS(
pubmed: 24189391
doi: 10.1016/j.clnu.2013.09.014
Chughtai B et al (2008) Fast track open partial nephrectomy: reduced postoperative length of stay with a goal-directed pathway does not compromise outcome. Adv Urol 2008:p507543
doi: 10.1155/2008/507543
Miao C et al (2020) Effect of enhanced recovery after surgery on postoperative recovery and quality of life in patients undergoing laparoscopic partial nephrectomy. Front Oncol 10:513874
pubmed: 33178573
pmcid: 7592390
doi: 10.3389/fonc.2020.513874
Lowrance WT et al (2010) Complications after radical and partial nephrectomy as a function of age. J Urol 183(5):1725–1730
pubmed: 20299040
pmcid: 4179201
doi: 10.1016/j.juro.2009.12.101
Khene ZE et al (2018) Predicting morbidity after robotic partial nephrectomy: The effect of tumor, environment, and patient-related factors. Urol Oncol 36(7):338.e19-338.e26
Zhang Z et al (2016) Acute kidney Injury after partial nephrectomy: role of Parenchymal Mass reduction and ischemia and impact on subsequent functional recovery. Eur Urol 69(4):745–752
pubmed: 26525838
doi: 10.1016/j.eururo.2015.10.023
Nientiedt M et al (2020) Chronic kidney Disease after partial nephrectomy in patients with preoperative inconspicuous renal function– curiosity or relevant Issue? Clin Genitourin Cancer 18(6):e754–e761
pubmed: 32660879
doi: 10.1016/j.clgc.2020.05.007
Waskowski J et al (2019) Mannitol for the Prevention of Peri-operative Acute kidney Injury: a systematic review. Eur J Vasc Endovasc Surg 58(1):130–140
pubmed: 31078413
doi: 10.1016/j.ejvs.2019.02.003
Krane LS et al (2016) A randomized double blinded placebo controlled trial of sildenafil for renoprotection prior to hilar clamping in patients undergoing robotic assisted laparoscopic partial nephrectomy. J Surg Oncol 114(7):785–788
pubmed: 27613357
doi: 10.1002/jso.24419
Buys-Gonçalves GF et al (2019) Antioxidants as Renoprotective agents for Ischemia during partial nephrectomy. Biomed Res Int 2019:p8575398
doi: 10.1155/2019/8575398
Molinari L, Sakhuja A, Kellum JA (2020) Perioperative Renoprotection: General mechanisms and Treatment approaches. Anesth Analg 131(6):1679–1692
pubmed: 33186157
pmcid: 8366579
doi: 10.1213/ANE.0000000000005107
Saugel B et al (2024) PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management. Br J Anaesth 133(2):264–276
pubmed: 38839472
pmcid: 11282474
doi: 10.1016/j.bja.2024.04.046
Weinberg L et al (2022) Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review. BMC Anesthesiol 22(1):69
pubmed: 35277122
pmcid: 8915500
doi: 10.1186/s12871-022-01605-9
Shaw AD et al (2022) Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study. Br J Anaesth 129(1):13–21
pubmed: 35595549
doi: 10.1016/j.bja.2022.03.027
Tang Y et al (2019) Association of Intraoperative Hypotension with Acute kidney Injury after noncardiac surgery in patients younger than 60 Years Old. Kidney Blood Press Res 44(2):211–221
pubmed: 30928979
doi: 10.1159/000498990
Ahuja S et al (2020) Associations of Intraoperative Radial arterial systolic, Diastolic, Mean, and pulse pressures with myocardial and acute kidney Injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology 132(2):291–306
pubmed: 31939844
doi: 10.1097/ALN.0000000000003048
Mathis MR et al (2020) Preoperative risk and the Association between Hypotension and postoperative acute kidney Injury. Anesthesiology 132(3):461–475
pubmed: 31794513
doi: 10.1097/ALN.0000000000003063
Stevens PE, Levin A (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158(11):825–830
pubmed: 23732715
doi: 10.7326/0003-4819-158-11-201306040-00007
Hung AJ et al (2013) Trifecta in partial nephrectomy. J Urol 189(1):36–42
pubmed: 23164381
doi: 10.1016/j.juro.2012.09.042
Shen W et al (2021) Impact of enhanced recovery after surgery (ERAS) protocol versus standard of care on postoperative Acute kidney Injury (AKI): a meta-analysis. PLoS ONE 16(5):e0251476
pubmed: 34015002
pmcid: 8136724
doi: 10.1371/journal.pone.0251476
Holubar SD et al (2017) American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery. Perioper Med (Lond) 6:4
pubmed: 28270910
doi: 10.1186/s13741-017-0059-2
Koerner CP et al (2019) Caution: increased acute kidney Injury in enhanced recovery after surgery (ERAS) protocols. Am Surg 85(2):156–161
pubmed: 30819291
doi: 10.1177/000313481908500221
Shim JW et al (2020) 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(8):1537–1548
pubmed: 32385595
doi: 10.1007/s00384-020-03616-9
Miller TE, Roche AM, Mythen M (2015) Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS). Can J Anaesth 62(2):158–168
pubmed: 25391735
doi: 10.1007/s12630-014-0266-y
Hassinger TE et al (2018) Acute kidney Injury in the age of enhanced recovery protocols. Dis Colon Rectum 61(8):946–954
pubmed: 29994959
pmcid: 6042978
doi: 10.1097/DCR.0000000000001059
Horres CR et al (2017) Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review. Perioper Med (Lond) 6:13
pubmed: 28948012
doi: 10.1186/s13741-017-0069-0
Doyle JF et al (2019) Does the implementation of a Quality Improvement Care Bundle reduce the incidence of Acute kidney Injury in patients undergoing emergency laparotomy? J Clin Med, 8(8)
Hobson C, Ruchi R, Bihorac A (2017) Perioperative acute kidney injury: risk factors and predictive strategies. Crit Care Clin 33(2):379–396
pubmed: 28284301
pmcid: 5617733
doi: 10.1016/j.ccc.2016.12.008
Mok V et al (2023) The impact of perioperative acute kidney injury/failure on short and long surgical outcomes. Anesthesiology Perioperative Sci 1(2):9
doi: 10.1007/s44254-022-00001-3
Weight CJ et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183(4):1317–1323
pubmed: 20171688
doi: 10.1016/j.juro.2009.12.030
Hu SL et al (2016) The nephrologist’s tumor: Basic Biology and Management of Renal Cell Carcinoma. J Am Soc Nephrol 27(8):2227–2237
pubmed: 26961346
pmcid: 4978061
doi: 10.1681/ASN.2015121335
Ercolino A et al (2021) Postoperative outcomes of fast-track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and trifecta proposal. Minerva Urol Nephrol 73(6):763–772
pubmed: 33200895
Dunkman WJ et al (2019) Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study. Perioperative Med 8(1):9
doi: 10.1186/s13741-019-0120-4