Acute Kidney Injury following Enhanced Recovery after Surgery in Patients Undergoing Radical Cystectomy

Hanna, Peter; Peterson, Matt; Albersheim, Jacob; Drawz, Paul; Zabell, Joseph; Konety, Badrinath R.; Weight, Christopher J.

doi:10.1097/ju.0000000000001153

Cited by 21 publications

(12 citation statements)

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“…One hypothesis is that AKI in these patients is in part due to the reduced post-operative fluid regimens implemented by ERAS in order to maximise early mobilisation. Such concerns have also been expressed in the use of ERAS in other surgical specialities [ 22 ]. Ongoing consideration of ways to optimise peri-operative fluid intake whilst maintaining the benefits of ERAS principles will be integral to optimising patient care in the future.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Farrow

Smillie

Duncumb

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Recent research has outlined the increasing incidence of acute kidney injury (AKI) and its effect on morbidity/mortality. There is evidence that current rates are significantly under-reported nationally, with uncertainty about pre-operative factors that might influence AKI reduction and the impact on other healthcare outcomes such as mortality and later Chronic Kidney Disease (CKD) development. We set out to help address these current deficiencies in the literature. Methods A retrospective cohort study was undertaken using data collected from patients undergoing elective primary lower limb arthroplasty within our institution from 01/10/16–31/09/17 with a 2-year follow-up. Results 53/782 (6.8%) patients had an AKI during the study time period. This was associated with a longer inpatient stay (p < 0.001). There was no significant difference in 30-day mortality (p = 0.134), 30-day readmission (p = 1.00) or later CKD development (p = 0.63). Independent predictors of AKI were as follows: Diabetes (OR 2.49; 95%CI 1.15–5.38; p = 0.021), CKD (OR 4.59; 95%CI 2.37–8.92; p < 0.001) and Male sex (OR 2.61; 95%CI 1.42–4.78; p = 0.002). Conclusions AKI in those undergoing hip and knee arthroplasty remains under-reported at a national level. AKI development was associated with an increased length of stay, but not long-term healthcare outcomes. This may be due to the mechanism of AKI development or the low absolute numbers of AKI suffered. We have identified three pre-operative factors (Diabetes, CKD & Male Sex) that were independently predictive of AKI. Targeted interventions may reduce the risk of AKI after lower limb arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Farrow

Smillie

Duncumb

et al. 2021

Eur J Orthop Surg Traumatol

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“…This retrospective single institution study of ERAS protocols after cystectomy by Hanna et al (page 982) from Minneapolis, Minnesota had provocative findings. 6 The incidence of acute kidney injury in patients on ERAS protocols was higher than in those treated without ERAS. Those who had demonstrable postoperative kidney injury were more likely to have stage 3 chronic kidney disease 3 months later even after adjustment for baseline renal function.…”

Section: Acute Kidney Injury Following Enhanced Recovery After Surgerymentioning

confidence: 96%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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Production, printing and distribution processes require a delay of several months between when a manuscript is accepted by The Journal of UrologyÒ and its appearance in print. Articles are posted online upon acceptance and are easily accessible immediately. Such timeliness is important for rapidly changing and fluid issues such as the COVID-19 pandemic. The Journal of Urology has been a leader in publishing relevant and important articles that help guide clinicians through the COVID crisis. This issue of The Journal contains many such articles including pieces for JU Forum, review articles and original scientific papers. All of these have been online for months, although appear in print now. Further, this contribution for This Month is being prepared several months before it will appear. Who knows what the COVID situation will look like 3 months in the future? One thing seems suredit will not be gone. Readers are advised to review the online version of The Journal to stay up to date on the most important information regarding this and other topics.

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“…Appropriately implemented criteria for the use of non-steroidal anti-inflammatory agents, such that patients with known renal dysfunction before surgery are not exposed can result in better outcomes. The topic continued to be a barrier to full implementation for specific team members and for others researching [ 85 , 86 , 87 , 88 , 89 ]. The key difference is pharmacists in our institution serve as the safety net for appropriate medication ordering as standardized order sets, and electronic decisions have been designed to help the initial ordering provider dose appropriately for these patients.…”

Section: Complicationsmentioning

confidence: 99%

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

Lovely

Larson

2021

Healthcare

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This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting.

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Acute Kidney Injury following Enhanced Recovery after Surgery in Patients Undergoing Radical Cystectomy

Cited by 21 publications

References 0 publications

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

This Month in Adult Urology

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

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