Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urol Oncol. 2022 Oct;40(10):453.e1-453.e7. doi: 10.1016/j.urolonc.2022.07.004. Epub 2022 Aug 8.
Recent reports have suggested that fluid restriction as part of Enhanced Recovery after Surgery (ERAS) pathways may increase the risk of AKI in radical cystectomy (RC) patients. We sought to evaluate the impact of ERAS initiation on AKI incidence at a high-volume tertiary care center.
We performed a retrospective review of our IRB approved database to identify patients receiving RC from 2010 to 2019. ERAS was initiated at our institution in October 2016. Acute kidney injuries were graded according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria and must have occurred within 7 days of indexed RC. Estimated glomerular filtration rate (eGFR) was captured at baseline, 1, 3, 6, and 12 months respectively. Categorical variables were compared with the Pearson-Chi square test. Quantitative variables were analyzed with the Wilcoxon-Rank sum test. Multivariable binary logistic regression and interaction analysis was used to identify predictors of AKI.
Twelve hundred patients were included. Twenty-two percent of patients experienced an AKI within 7 days. Patients in the ERAS cohort experienced less AKIs after RC (18% vs. 25%, P = 0.003). When adjusting for year of surgery, ERAS was not a significant predictor for AKI on multivariable analysis (OR: 0.87, P = 0.73). On interaction analysis, during the ERAS era, intracorporeal robot-assisted radical cystectomy (iRARC) was associated with decreased odds of AKI (OR: 0.39, P = 0.034). There were no significant differences in eGFR at 12 months postoperatively (P = 0.16).
Unlike previous reports, ERAS initiation was not associated with increased risk of AKI at a tertiary care high-volume center.
最近的报告表明，作为术后强化康复（ERAS）方案的一部分，液体限制可能会增加根治性膀胱切除术（RC）患者发生急性肾损伤（AKI）的风险。我们旨在评估在高容量三级护理中心实施 ERAS 方案对 AKI 发生率的影响。
我们对经过机构审查委员会批准的数据库进行了回顾性分析，以确定 2010 年至 2019 年期间接受 RC 的患者。我们的机构于 2016 年 10 月开始实施 ERAS。根据肾脏病改善全球结局（KDIGO）标准对急性肾损伤进行分级，并且必须在 RC 后 7 天内发生。分别在基线、1 个月、3 个月、6 个月和 12 个月时采集估算肾小球滤过率（eGFR）。采用 Pearson 卡方检验比较分类变量，采用 Wilcoxon 秩和检验分析定量变量。采用多变量二项逻辑回归和交互分析来确定 AKI 的预测因素。
共纳入 1200 例患者。22%的患者在 7 天内发生 AKI。接受 ERAS 方案的 RC 患者 AKI 发生率较低（18% vs. 25%，P=0.003）。多变量分析中，调整手术年份后，ERAS 不是 AKI 的显著预测因素（OR：0.87，P=0.73）。在交互分析中，在 ERAS 时代，经腹腔机器人辅助 RC（iRARC）与 AKI 风险降低相关（OR：0.39，P=0.034）。术后 12 个月时 eGFR 无显著差异（P=0.16）。
与先前的报告不同，在三级护理高容量中心，实施 ERAS 方案与 AKI 风险增加无关。
