Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan 8.
doi: 10.1097/EJA.0000000000002339. Online ahead of print.

Association of perioperative fluid balance and acute kidney injury in patients undergoing elective colorectal surgery: A pre-planned secondary analysis of a multicentre prospective observational study

Alejandro Suárez-de-la-Rica  1 , Javier Ripollés-Melchor, Ane Abad-Motos, César Aldecoa, Carlos Ferrando, Alfredo Abad-Gurumeta, Mariana Díaz-Almirón, Rubén Casans-Francés, Margarita Logroño-Egea, José Antonio García-Erce, José M Ramírez Rodríguez, Ana Cuellar-Martínez, Sandra Marmaña-Mezquita, Emilio Maseda; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (RedGERM-SPARN)
Collaborators, Affiliations

Association of perioperative fluid balance and acute kidney injury in patients undergoing elective colorectal surgery: A pre-planned secondary analysis of a multicentre prospective observational study

Alejandro Suárez-de-la-Rica et al. Eur J Anaesthesiol. .

Abstract

Background: Acute kidney injury (AKI) is a common complication after surgery. Greater fluid administration has been related to an increased incidence in patients undergoing major surgery but there are no large series of patients in specific perioperative settings showing relationship between fluid balance and the occurrence of AKI.

Objective: This study tested the hypothesis that higher perioperative fluid balance was associated with an increased risk of postoperative AKI.

Design: Prospective observational study. Predefined secondary sub-study of the Postoperative Outcomes Within Enhanced Recovery After Surgery (POWER) study.

Setting: A pre-planned secondary analysis of a multicentre study in 80 hospitals in Spain during a single period of 2 months of recruitment between September and December 2017.

Patients: Patients undergoing elective primary colorectal surgery with a planned overnight stay were included if they had complete data regarding postoperative fluid balance. Patients who underwent urgent or emergency surgery or with estimated glomerular filtration rate less than 30 ml min-1 were excluded.

Main outcomes measures: The primary outcome was the occurrence of AKI (mild, moderate, or severe) at 30 days following surgery. AKI was defined according to KDIGO and EPCO guidelines, incorporating serum creatinine and urine output criteria.

Results: A total of 1139 patients were included in the study. Of these, 73 patients (6.4%) developed acute kidney injury in the postoperative period. The adjusted relative risks (RR) that compared the quartile with the lowest perioperative fluid balance (Q1) with other quartiles were 4.10 [95% confidence interval (CI), 1.60 to 10.51] for Q3 and 4.81 (95% CI, 1.91 to 12.11) for Q4. In the Poisson loglinear model after adjusting by sex, ASA grade, Enhanced Recovery After Surgery (ERAS) adherence and intraoperative bleeding, RR for AKI were higher with a higher positive perioperative fluid balance (quadratic nonlinear P < 0.01).

Conclusions: In this secondary analysis, we found that higher positive perioperative fluid balance during the first 24 h was associated with an increased risk of postoperative acute kidney injury in patients undergoing elective colorectal surgery.

Trial registration: Clinicaltrials.com identifier: NCT03012802.

PubMed Disclaimer

References

    1. O’Connor ME, Kirwan CJ, Pearse RM, et al. Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med 2016; 42:521–530.
    1. Kork F, Balzer F, Spies CD, et al. Minor postoperative increases of creatinine are associated with higher mortality and longer hospital length of stay in surgical patients. Anesthesiology 2015; 123:1301–1311.
    1. Korenkevych D, Ozrazgat-Baslanti T, Thottakkara P, et al. The pattern of longitudinal change in serum creatinine and 90-day mortality after major surgery. Ann Surg 2016; 263:1219–1227.
    1. Grams ME, Sang Y, Coresh J, et al. Acute kidney injury after major surgery: a retrospective analysis of Veterans Health Administration data. Am J Kidney Dis 2016; 67:872–880.
    1. Bihorac A, Yavas S, Subbiah S, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg 2009; 249:851–858.

Associated data

LinkOut - more resources