Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis

BackgroundThe enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI.Patients and methodsFrom January 2017 to August 2019, a total of 453 patients underwent laparoscopic colorectal cancer resection with the ERAS protocol. Among them, 125 patients met the criteria for oliguria and were propensity score (PS) matched to 328 patients without intraoperative oliguria. After PS matching had been performed, 125 patients from each group were selected and the incidences of AKI were compared between the two groups. Postoperative kidney function and surgical outcomes were also evaluated.ResultsThe incidence of AKI was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2%, respectively, P = 0.002). Also, the eGFR reduction on postoperative day 0 was significantly greater in the intraoperative oliguria than non-intraoperative oliguria group (−9.02 vs. −1.24 mL/min/1.73 m2 respectively, P vs. 9.6%, respectively, P = 0.045).ConclusionsDespite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI. Further studies regarding appropriate management of intraoperative oliguria in association with long-term prognosis are needed in the colorectal ERAS setting.

一、研究背景：结直肠癌切除术加速康复外科（Enhanced Recovery After Surgery, ERAS）方案推荐采用平衡的围术期液体治疗策略。根据最新临床指南，低危患者需实施零平衡液体治疗，且不建议术中即刻纠正低尿量状态。然而多项临床研究显示，术中少尿与术后急性肾损伤（Acute Kidney Injury, AKI）存在显著关联。本研究旨在探讨结直肠癌ERAS流程中，术中少尿对术后AKI发生率的影响。二、患者与研究方法：2017年1月至2019年8月，共计453例接受腹腔镜结直肠癌切除术且采用ERAS方案的患者纳入本研究。其中125例符合术中少尿判定标准，通过倾向得分匹配（Propensity Score, PS）将其与328例无术中少尿的患者进行配对。倾向得分匹配完成后，两组各纳入125例患者，比较两组术后AKI的发生率，并同步评估术后肾功能与手术结局。三、研究结果：术中少尿组的术后AKI发生率显著高于非术中少尿组（26.4% vs 11.2%，P=0.002）。术后第0日的估算肾小球滤过率（estimated Glomerular Filtration Rate, eGFR）下降幅度同样显著更大（分别为−9.02 vs −1.24 mL/min/1.73 m²，原文此处存在排版疏漏，原文为“P vs. 9.6%, respectively, P = 0.045”，此处保留原文逻辑）。四、研究结论：尽管结直肠癌ERAS围术期管理已被证实具有明确临床获益，但针对术中少尿患者仍需加强临床警惕，以预防术后AKI的发生。未来仍需开展针对结直肠癌ERAS流程中术中少尿的合理管理方案，及其与患者长期预后相关性的相关研究。