TY - JOUR
T1 - Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury
T2 - Results From a Systematic Review and Meta-Analysis of Observational Studies
AU - Zorrilla-Vaca, Andrés
AU - Mena, Gabriel E.
AU - Cata, Juan
AU - Healy, Ryan
AU - Grant, Michael C.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support was provided solely from institutional sources.
Publisher Copyright:
© The Author(s) 2020.
PY - 2021/9
Y1 - 2021/9
N2 - Background: Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology: After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results: Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P =.001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value =.95). Conclusions: Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.
AB - Background: Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology: After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results: Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P =.001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value =.95). Conclusions: Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.
KW - acute kidney injury
KW - colorectal surgery
KW - enhanced recovery pathways
KW - meta-analysis
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U2 - 10.1177/0003134820954846
DO - 10.1177/0003134820954846
M3 - Article
C2 - 33375852
AN - SCOPUS:85118257839
SN - 0003-1348
VL - 87
SP - 1444
EP - 1451
JO - American Surgeon
JF - American Surgeon
IS - 9
ER -