Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

Goal-Directed Fluid Therapy Does Not Impact Renal Outcomes in an Enhanced Recovery Program

BACKGROUND

Goal-directed fluid therapy (GDFT) has been proposed as a cornerstone for Enhanced Recovery After Surgery (ERAS) programs, particularly among high-risk patients undergoing high-risk surgery. However, due to the increased advocacy of euvolemia before surgery, the utility of GDFT in the context of ERAS is being questioned. Our primary objective was to determine whether GDFT has any impact on daily postoperative renal outcomes among high-risk patients undergoing thoracic surgery in an ERAS program.

METHODS

All patients included in this study were high-risk with a baseline GFR below 90 mL/min/1.73m² and classified as American Society of Anesthesiologists status III/IV. Patients were categorized into two groups according to the intraoperative use of GDFT. Both groups were matched in a 1:1 fashion using propensity scores. Our renal outcomes included changes in daily glomerular filtration rates (GFRs) from post-anesthesia care unit through postoperative day 5.

RESULTS

In total 451 matched pairs were included in this analysis. Both groups had similar demographics and clinical characteristics. Patients treated with GDFT received more ephedrine (5mg [0-15] vs 0mg [0-15], P=0.03) and less volume of fluids (1163±484mL vs 1246±626mL, P=0.03) compared to those in the standard group. The incidence of AKI was similar in both groups (5.1% in the GDFT group vs 7.1% in non-GDFT group, P=0.57). Mixed effect analysis showed no significant differences in the trajectory of postoperative GFRs between both groups (P=0.59).

CONCLUSIONS

GDFT does not impact postoperative renal function compared to standard of care among high-risk patients in an ERAS program for thoracic pulmonary surgery.