Intraoperative oliguria predicts acute kidney injury after major abdominal surgery

Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients. Preoperative hydration with (complex) carbohydrate drinks up until 2 h before surgery is safe and should be encouraged, as this helps improve metabolism, decrease insulin resistance, reduce anxiety, and reduce nausea and vomiting. During the intraoperative period, the goals of fluid management are to maintain euvolemia using an individualized plan for fluid and haemodynamic management, matching the needs for monitoring with patient and surgical risk through goal-directed therapy (GDT). By combining the use of fluids and inotropes, GDT uses measurements and indicators of cardiac output and stroke volume to improve blood flow intraoperatively, and ultimately reduce LOS and complications. In the postoperative period, an early transition to oral hydration helps to enhance the conditions for healing and recovery from surgery. I.V. fluid therapy should be kept at a minimum, and urine output should not be the driving force for fluid administration. The optimization of perioperative fluid management is critical to ERPs as it helps improve pulmonary function, tissue oxygenation, gastrointestinal motility, and wound healing.

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“…5 Recent studies suggest 0.3 ml kg À1 h À1 as a threshold for increased risk of acute kidney injury in major abdominal surgery. 61…”

Section: Oliguria In the Postoperative Periodmentioning

confidence: 99%

Current concepts of fluid management in enhanced recovery pathways

Makaryus

Miller

Gan

2018

British Journal of Anaesthesia

145

104

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“…This article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines [17]. We recruited patients using the database created for our previous study investigating the relationship between intraoperative oliguria and AKI after major abdominal surgery [18]. Patients 18 years or older who underwent major abdominal surgery (liver, colorectal, gastric, pancreatic, or esophageal resection) under general anesthesia at Kyoto University Hospital from March 2008 to April 2015 were eligible for inclusion.…”

Section: Study Design Setting and Patientsmentioning

confidence: 99%

“…The research database for our previous study [18] included age, sex, preoperative comorbidities, American Society of Anesthesiologists Physical Status, preoperative serum creatinine (SCr) (the most recent SCr level measured before surgery), type of surgery, SCr during the 7 days after surgery, postoperative length of hospital stay, and in-hospital mortality. In addition, data on survival time during the year after surgery and SCr at 3 months and 1 year post-surgery were collected from the electronic medical record system.…”

Section: Data Collectionmentioning

confidence: 99%

Transient acute kidney injury after major abdominal surgery increases chronic kidney disease risk and 1-year mortality

Mizota

Dong

Takeda

et al. 2019

Journal of Critical Care

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Purpose:We conducted a retrospective cohort study to determine incidences of transient and persistent acute kidney injury (AKI) after major abdominal surgery and their impacts on long-term outcome. Materials and Methods:We enrolled 3,751 patients undergoing major abdominal surgery.Postoperative AKI was classified as transient or persistent based on the return of serum creatinine to the non-AKI range within 7 days post-surgery. Primary outcome was mortality within 1 year. We used multivariable Cox proportional hazard regression analysis to assess independent associations between AKI type and mortality.Results: Most patients with AKI were classified as transient (84%). Compared to patients without AKI, both patients with transient and persistent AKI demonstrated elevated 1-year mortality rates [adjusted hazard ratio (95% confidence interval): 2.01 (1.34-2.93); P = 0.001, and 6.20 (3.00-11.43); P < 0.001, respectively] and greater risk of chronic kidney disease progression at 1 year [adjusted odds ratio (95% confidence interval): 3.87 (2.12-7.08) and 23.70 (9.64-58.22), respectively; both P < 0.001]. Conclusions:Although most AKI cases after major abdominal surgery recover completely within 7 days, even these patients with transient AKI are at higher risk for 1-year mortality and chronic kidney disease progression compared to patients without AKI.

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“…LCA is widely used in social science research but has been applied to clinical datasets to identify subphenotypes of acute respiratory distress syndrome patients, 25 asthma patients, 26 and most recently to establish comorbidity profiles in patients undergoing surgery for colorectal cancer. 27 Only variables known preoperatively were incorporated in the LCA model as the preoperative comorbid state was the focus of the analysis, but other intraoperative and postoperative factors, such as individualized intraoperative blood pressure management, 28,29 intraoperative oliguria, 30 and other postoperative complications 8 are clearly associated with postoperative AKI and mortality. Future studies will identify the relationships that the preoperative comorbid state and these other factors have to influence postoperative mortality.…”

Section: Discussionmentioning

confidence: 99%

Latent class analysis stratifies mortality risk in patients developing acute kidney injury after high-risk intraabdominal general surgery: a historical cohort study

Kim

Wall

Kiran

et al. 2018

Can J Anesth/J Can Anesth

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Intraoperative oliguria predicts acute kidney injury after major abdominal surgery

Abstract: Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3 ml kg -1 h -1 was significantly associated with increased risk of postoperative AKI.

Cited by 100 publications

References 28 publications

Current concepts of fluid management in enhanced recovery pathways

Current concepts of fluid management in enhanced recovery pathways

Transient acute kidney injury after major abdominal surgery increases chronic kidney disease risk and 1-year mortality

Latent class analysis stratifies mortality risk in patients developing acute kidney injury after high-risk intraabdominal general surgery: a historical cohort study

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