Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Langenbecks Arch Surg. 2024 Oct 23;409(1):319. doi: 10.1007/s00423-024-03513-7.
Evaluation of a kidney-adjusted enhanced recovery after surgery (ERAS) protocol (kERAS) in patients undergoing nephron-sparing surgery (PN).
The kERAS protocol is a multidimensional protocol focusing on optimized perioperative fluid and nutrition management as well as strict intraoperative and postoperative blood pressure limits. It was applied in a prospective cohort (n = 147) of patients undergoing open or robotic PN. Patients were analyzed for the development of acute postoperative renal failure (AKI), achievement of TRIFECTA criteria, upstaging or new onset of chronic kidney disease (CKD) and length of hospital stay (LOS) and compared to a retrospective cohort (n = 162) without application of the protocol.
Cox regression analyses could not confirm a protective effect of kERAS on the development of AKI post-surgery. A positive effect was observed on TRIFECTA achievement (OR 2.2, 95% CI 1.0-4.5, p = 0.0374). Patients treated with the kERAS protocol showed less long-term CKD upstaging compared to those treated with the standard protocol (p = 0.0033). There was no significant effect on LOS and new onset of CKD.
The implementation of a kERAS protocol can have a positive influence on long-term renal function in patients undergoing PN. It can be used safely without promoting AKI. Furthermore, it can be realized with a manageable amount of additional effort.
评估接受保肾手术（PN）的患者的肾脏调整后的术后加速康复（ERAS）方案（kERAS）。
kERAS 方案是一个多维方案，侧重于优化围手术期液体和营养管理以及严格的术中及术后血压限制。它应用于前瞻性队列（n=147）的开放性或机器人辅助 PN 患者。分析患者急性术后肾功能衰竭（AKI）的发生、TRIFECTA 标准的达成、CKD 的升级或新发及住院时间（LOS），并与未应用该方案的回顾性队列（n=162）进行比较。
Cox 回归分析不能证实 kERAS 对术后 AKI 的发生有保护作用。TRIFECTA 达标观察到积极的效果（OR 2.2，95%CI 1.0-4.5，p=0.0374）。与标准方案治疗的患者相比，接受 kERAS 方案治疗的患者长期 CKD 升级较少（p=0.0033）。对 LOS 和 CKD 的新发无显著影响。
实施 kERAS 方案可对接受 PN 的患者的长期肾功能产生积极影响。在不促进 AKI 的情况下，可以安全使用。此外，它可以通过管理工作量来实现。
