Jung-Woo Shim1, Hojun Ro2, Chul Seung Lee3, Jaesik Park1, Hyung Mook Lee1, Yong-Suk Kim1, Young Eun Moon1, Sang Hyun Hong1, Min Suk Chae4. 1. Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 3. Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 4. Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. shscms@gmail.com.
Abstract
BACKGROUND: Although many reports have shown that enhanced recovery after surgery (ERAS) programs improve the perioperative outcomes of patients undergoing colorectal surgery, the prevalence of early acute kidney injury (AKI) after surgery in such patients requires attention. Protective roles of the female sex in terms of chronic kidney disease and progression of ischemic renal injury have been described in many studies. We thus explored whether a sex difference was evident in terms of postoperative AKI in a colorectal ERAS setting. METHODS: From January 2017 to August 2019, 453 patients underwent laparoscopic colorectal cancer resection in an enhanced recovery program. Of these, 217 female patients were propensity score (PS)-matched with 236 male patients. Then, 215 patients of either sex were compared in terms of postoperative renal function and complications. RESULTS: Among the PS-matched patients, the incidence of AKI was significantly higher in male than female patients (24.2% vs. 9.8%, P < 0.001). Male patients also exhibited a greater reduction in the postoperative estimated glomerular filtration rate, compared with female patients. The male sex was associated with an approximately threefold increase in the risk of AKI. The rate of surgical complications was significantly higher in male than female patients. CONCLUSIONS: Caution must be taken to prevent postoperative AKI in patients (particularly males) participating in colorectal ERAS programs. The mechanism underlying the sex difference remains unclear. Additional studies are required to determine whether male patients require perioperative management that differs from that of females, to prevent postoperative AKI.
BACKGROUND: Although many reports have shown that enhanced recovery after surgery (ERAS) programs improve the perioperative outcomes of patients undergoing colorectal surgery, the prevalence of early acute kidney injury (AKI) after surgery in such patients requires attention. Protective roles of the female sex in terms of chronic kidney disease and progression of ischemic renal injury have been described in many studies. We thus explored whether a sex difference was evident in terms of postoperative AKI in a colorectal ERAS setting. METHODS: From January 2017 to August 2019, 453 patients underwent laparoscopic colorectal cancer resection in an enhanced recovery program. Of these, 217 female patients were propensity score (PS)-matched with 236 male patients. Then, 215 patients of either sex were compared in terms of postoperative renal function and complications. RESULTS: Among the PS-matched patients, the incidence of AKI was significantly higher in male than female patients (24.2% vs. 9.8%, P < 0.001). Male patients also exhibited a greater reduction in the postoperative estimated glomerular filtration rate, compared with female patients. The male sex was associated with an approximately threefold increase in the risk of AKI. The rate of surgical complications was significantly higher in male than female patients. CONCLUSIONS: Caution must be taken to prevent postoperative AKI in patients (particularly males) participating in colorectal ERAS programs. The mechanism underlying the sex difference remains unclear. Additional studies are required to determine whether male patients require perioperative management that differs from that of females, to prevent postoperative AKI.
Authors: J Wind; S W Polle; P H P Fung Kon Jin; C H C Dejong; M F von Meyenfeldt; D T Ubbink; D J Gouma; W A Bemelman Journal: Br J Surg Date: 2006-07 Impact factor: 6.939
Authors: U O Gustafsson; M J Scott; M Hubner; J Nygren; N Demartines; N Francis; T A Rockall; T M Young-Fadok; A G Hill; M Soop; H D de Boer; R D Urman; G J Chang; A Fichera; H Kessler; F Grass; E E Whang; W J Fawcett; F Carli; D N Lobo; K E Rollins; A Balfour; G Baldini; B Riedel; O Ljungqvist Journal: World J Surg Date: 2019-03 Impact factor: 3.352
Authors: Crystal P Koerner; Alexandra G Lopez-Aguiar; Mohammad Zaidi; Shelby Speegle; Glen Balch; Virginia O Shaffer; Charles A Staley; Jahnavi Srinivasan; Shishir K Maithel; Patrick S Sullivan Journal: Am Surg Date: 2019-02-01 Impact factor: 0.688
Authors: Joseph H Marcotte; Kinjal Patel; Ronak Desai; John P Gaughan; Deviney Rattigan; Kevin W Cahill; Robin F Irons; Justin Dy; Monika Dobrowolski; Helena McElhenney; Michael Kwiatt; Steven McClane Journal: Int J Colorectal Dis Date: 2018-05-28 Impact factor: 2.571
Authors: L Basse; H H Raskov; D Hjort Jakobsen; E Sonne; P Billesbølle; H W Hendel; J Rosenberg; H Kehlet Journal: Br J Surg Date: 2002-04 Impact factor: 6.939
Authors: Sachin Kheterpal; Kevin K Tremper; Michael Heung; Andrew L Rosenberg; Michael Englesbe; Amy M Shanks; Darrell A Campbell Journal: Anesthesiology Date: 2009-03 Impact factor: 7.892
Authors: Fabian Grass; Jenna K Lovely; Jacopo Crippa; Kellie L Mathis; Martin Hübner; David W Larson Journal: World J Surg Date: 2019-05 Impact factor: 3.352