Key result
ERAS protocols linked to ~54% lower postoperative AKI risk in major elective surgery.
Why the study?
Postoperative acute kidney injury is a frequent and clinically consequential complication after major surgery, prompting evaluation of how ERAS adherence relates to AKI incidence.
Does adherence to enhanced recovery after surgery (ERAS) protocols reduce the incidence of postoperative acute kidney injury (AKI) in adult patients undergoing major elective surgery?
Observational (n=355)
No
Does adherence to enhanced recovery after surgery (ERAS) protocols reduce the incidence of postoperative acute kidney injury (AKI) in adult patients undergoing major elective surgery?
Effect estimate: aOR 0.46 (95% CI 0.24-0.87)
Absolute Event Rate: 8.2% vs 18.5%
p-value: p=0.015
Implementation of ERAS protocols in major elective surgery is associated with a significant reduction in postoperative AKI, shorter hospital stays, and fewer ICU admissions.
ERAS adherence may lower postoperative AKI in elective surgery; hypothesis-generating and requires RCTs before practice change.
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.
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Sattar et al. (2026) conducted an observational in Adult patients undergoing major elective gastrointestinal, hepatobiliary, gynecologic oncology, or urologic surgery (n=355). Enhanced Recovery After Surgery (ERAS) protocols vs. Conventional perioperative care was evaluated on Postoperative acute kidney injury (AKI) defined by KDIGO criteria (increase in serum creatinine ≥ 0.3 mg/dL within 48 hours or ≥ 1.5× baseline within 7 days) (aOR 0.46, 95% CI 0.24-0.87, p=0.015). Enhanced Recovery After Surgery protocols reduced the incidence of postoperative acute kidney injury from 18.5% to 8.2% with an adjusted odds ratio of 0.46 (95% CI 0.24-0.87; P=0.015) in adults undergoing major elective surgery.
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