Retrospective review of anesthesia techniques and postoperative complications in patients with uremia undergoing colorectal cancer surgery.

BACKGROUND

Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.

AIM

To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.

METHODS

This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.

RESULTS

Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% 26.7%, = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL 3100 mL, < 0.001) and lower complication rates (19.5% 28.2%, = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days 11 days; < 0.001) and higher rates of major complications (27.8% 13.5%; = 0.003).

CONCLUSION

In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.