Cureus · 2026
Role of Enhanced Recovery After Surgery (ERAS) Protocols in Preventing Postoperative Acute Kidney Injury (AKI).
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Sattar Zakariya, Yousaf Aakif, Zubair Muhammad, Pathan Muhammad R, Rasheed Zai Abdul, Ahmed Javed
Аннотация
BACKGROUND: Postoperative acute kidney injury (AKI) is a frequent and clinically consequential complication after major surgery.
OBJECTIVE: To evaluate the association between enhanced recovery after surgery (ERAS) adherence and postoperative AKI incidence in patients undergoing major elective surgery.
METHODOLOGY: This prospective observational study was conducted at Sahiwal Teaching Hospital, Sahiwal, from November 2024 to April 2025. A total of 355 adult surgical patients were included; 182 (51.3%) received ERAS-based perioperative care, and 173 (48.7%) received conventional care. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographics, comorbidities, intraoperative variables, fluid balance, and ERAS adherence scores were recorded.
RESULTS: AKI occurred in 46 patients (12.9%) overall. Incidence was significantly lower in the ERAS group compared with conventional care (15, 8.2%, vs. 32, 18.5%, P = 0.004). Postoperative length of stay was shorter with ERAS (6.2 ± 2.9 vs. 8.7 ± 3.4 days, P < 0.001), and ICU admission was less frequent (27, 14.8%, vs. 40, 23.1%, P = 0.04). On multivariable analysis, ERAS adherence ≥70% independently reduced the odds of AKI (aOR 0.46; 95% confidence interval (CI) 0.24-0.87; P = 0.015), whereas positive fluid balance >2 L (P = 0.001), baseline eGFR <60 (P = 0.021), and intraoperative hypotension (P = 0.020) were independent risk factors.
CONCLUSIONS: ERAS implementation is associated with a substantial reduction in postoperative AKI, shorter hospitalization, and fewer critical care escalations. Findings support positioning ERAS not only as a recovery pathway but as a renal-protective perioperative strategy.
OBJECTIVE: To evaluate the association between enhanced recovery after surgery (ERAS) adherence and postoperative AKI incidence in patients undergoing major elective surgery.
METHODOLOGY: This prospective observational study was conducted at Sahiwal Teaching Hospital, Sahiwal, from November 2024 to April 2025. A total of 355 adult surgical patients were included; 182 (51.3%) received ERAS-based perioperative care, and 173 (48.7%) received conventional care. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographics, comorbidities, intraoperative variables, fluid balance, and ERAS adherence scores were recorded.
RESULTS: AKI occurred in 46 patients (12.9%) overall. Incidence was significantly lower in the ERAS group compared with conventional care (15, 8.2%, vs. 32, 18.5%, P = 0.004). Postoperative length of stay was shorter with ERAS (6.2 ± 2.9 vs. 8.7 ± 3.4 days, P < 0.001), and ICU admission was less frequent (27, 14.8%, vs. 40, 23.1%, P = 0.04). On multivariable analysis, ERAS adherence ≥70% independently reduced the odds of AKI (aOR 0.46; 95% confidence interval (CI) 0.24-0.87; P = 0.015), whereas positive fluid balance >2 L (P = 0.001), baseline eGFR <60 (P = 0.021), and intraoperative hypotension (P = 0.020) were independent risk factors.
CONCLUSIONS: ERAS implementation is associated with a substantial reduction in postoperative AKI, shorter hospitalization, and fewer critical care escalations. Findings support positioning ERAS not only as a recovery pathway but as a renal-protective perioperative strategy.