Maddy Brandon P, Tischer Kristin M, McGree Michaela E, Fought Angela J, Dowdy Sean C, Glaser Gretchen E
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2025 Jan;192:181-188. doi: 10.1016/j.ygyno.2024.12.005. Epub 2024 Dec 18.
To compare the incidence of acute kidney injury (AKI) among patients undergoing gynecologic surgery before and after implementing an Enhanced Recovery After Surgery (ERAS) pathway.
We conducted a retrospective review of medical records from Mayo Clinic during three time periods when ERAS was used, focusing on patients who underwent open gynecologic surgery. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria. We used inverse-probability of treatment weighting (IPTW) to adjust for baseline covariates between pre-ERAS (135 patients) and post-ERAS (486 patients) cohorts. Statistical comparisons were made using t-test, Wilcoxon rank-sum, chi-square or Fisher's exact test, and univariate logistic regression with odds ratio (OR) and 95 % confidence interval (CI).
Pre-IPTW, the AKI incidence was similar between cohorts (10.4 % vs 8.4 %, p = 0.48), and the odds of AKI for post-ERAS patients compared to pre-ERAS was not significant (OR 0.80, 95 % CI 0.42-1.51). After IPTW-adjustment, the AKI incidence remained comparable (10.3 % vs 8.1 %, p = 0.41), with the odds ratio unchanged (OR 0.76, 95 % CI 0.40-1.45). AKI patients were older (mean 67.0 vs 62.4 years, p < 0.01), had higher ASA scores (61.8 % vs 45.2 %, p = 0.02), lower preoperative hemoglobin (median 10.8 vs 12.5 g/dL, p < 0.01), longer surgeries (median 331 vs 222 min, p < 0.01), greater intraoperative blood loss (median 800 vs 500 mL, p < 0.01), more transfusions (56.4 % vs 29.3 %, p < 0.01), and higher fluid volumes (median 5750 vs 4165 mL, p < 0.01).
The ERAS pathway did not significantly impact AKI incidence in gynecologic surgery patients. AKI remains associated with increased postoperative complications, highlighting the need for improved risk prediction and preventive strategies.
比较实施加速康复外科（ERAS）路径前后接受妇科手术患者的急性肾损伤（AKI）发生率。
我们对梅奥诊所三个使用ERAS时期的病历进行了回顾性研究，重点关注接受开放性妇科手术的患者。AKI采用改善全球肾脏病预后组织（KDIGO）标准进行定义。我们使用治疗权重逆概率（IPTW）来调整ERAS前（135例患者）和ERAS后（486例患者）队列之间的基线协变量。采用t检验、Wilcoxon秩和检验、卡方检验或Fisher精确检验以及单因素逻辑回归分析，计算比值比（OR）和95%置信区间（CI）进行统计比较。
在IPTW调整前，各队列之间的AKI发生率相似（10.4%对8.4%，p = 0.48），与ERAS前患者相比，ERAS后患者发生AKI的几率无显著差异（OR 0.80，95% CI 0.42 - 1.51）。经过IPTW调整后，AKI发生率仍具有可比性（10.3%对8.1%，p = 0.41），比值比不变（OR 0.76，95% CI 0.40 - 1.45）。AKI患者年龄更大（平均67.0岁对62.4岁，p < 0.01），美国麻醉医师协会（ASA）评分更高（61.8%对45.2%，p = 0.02），术前血红蛋白水平更低（中位数10.8对12.5 g/dL，p < 0.01），手术时间更长（中位数331对222分钟，p < 0.01），术中失血量更多（中位数800对500 mL，p < 0.01），输血次数更多（56.4%对29.3%，p < 0.01），液体摄入量更高（中位数5750对4165 mL，p < 0.01）。
ERAS路径对妇科手术患者的AKI发生率没有显著影响。AKI仍然与术后并发症增加相关，这突出了改善风险预测和预防策略的必要性。
