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Abstract
Introduction: The implementation of the ERAS (Enhanced Recovery After Surgery) protocol in thoracic surgery has implied a change in the perioperative management of patients. One of the new recommendations is to avoid systemic urinary catheter placement in lung surgery.
There is little evidence in the literature on postoperative nephrourourological complications (URC). Therefore, we designed a study to evaluate the incidence of CRU in the population undergoing pulmonary resection by videothoracoscopy.
Material and Methods: We conducted a longitudinal and prospective study in the Post Anaesthesia Resuscitation Unit (PACU) in a tertiary hospital during the period from April 2019 to July 2020. Perioperative variables as well as the presence of CRU were collected.
Results: Of the 62 patients (82%) admitted to PACU without a urinary catheter, 5 (8%) had CRU. Of the patients with complications, 60% (3 out of 5) had high ultrasound-estimated bladder volumes (>300 ml) on admission to PACU and 80% (4 out of 5) at 4 hours. These complications did not imply significant deterioration of renal function during admission.
Conclusions: The recommendation to avoid urinary catheterisation in lung resection surgery appears to be a safe practice, although there is a non-negligible incidence of CRU in the immediate postoperative period. It would be very interesting to have tools that allow detection and monitoring of patients at increased risk to favour early detection of complications.
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Copyright (c) 2022 Sonia Martín Baeza, Livia Franco De La Fuente , Isabel Vila Cubell , Esther Díaz Sánchez, Alicia Irene Gasulla Guillermo , Ricard Navarro- Ripoll (Autor/a)
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References
- Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101(3):172-88. DOI: https://doi.org/10.1002/bjs.9394
- Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERASVR ) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91-115. DOI: https://doi.org/10.1093/ejcts/ezy301
- Wind J, Polle SW, Fung Kon Jin PHP, Dejonj CHC, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800-9. DOI: https://doi.org/10.1002/bjs.5384
- Puckett JR, Pickering JW, Palmer SC, McCall JL, Kluger MT, De Zoysa J, et al. Low versus standard urine output targets in patients undergoing major abdominal surgery: a randomized noninferiority trial. Ann Surg. 2017;265(5):874-81. DOI: https://doi.org/10.1097/SLA.0000000000002044
- Licker M, Cartier V, Robert J, Diaper J, Villiger Y, Tschopp JM, et al. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery Ann. Thorac. Surg. 2011;91(3):844-50. DOI: https://doi.org/10.1016/j.athoracsur.2010.10.037
- Matot I, Dery E, Bulgov Y, Cohen B, Paz J, Nesher N. Fluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function. J Thorac Cardiovasc Surg. 2013;146(2):461-6. DOI: https://doi.org/10.1016/j.jtcvs.2013.02.015
- Kim KW, Lee JI, Kim JS, Lee YJ, Choi WJ, Jung H, et al. Risk factors for urinary retention following minor thoracic surgery. Interact CardioVasc Thorac Surg. 2015;20(4):486-92. DOI: https://doi.org/10.1093/icvts/ivu445
- Allen MS, Blackmon SH, Nichols FC, Cassivi SD, Harmsen WS, Lechtenberg B, et al. Optimal timing of urinary catheter removal after thoracic operations: a randomized controlled study. Ann Thorac Surg. 2016;102(3):925-30. DOI: https://doi.org/10.1016/j.athoracsur.2016.03.115
- Egal M, de Geus HR, van Bommel J, Groeneveld AB. Targeting oliguria reversal in perioperative restrictive fluid management does not influence the occurrence of renal dysfunction: a systematic review and meta-analysis. Eur J Anaesthesiol. 2016;33(6):425-35. DOI: https://doi.org/10.1097/EJA.0000000000000416
- Carrillo Esper R, Castro Padilla JF. Escala RIFLE. Fundamentos y su impacto en el diagnóstico, pronóstico y manejo de la lesión renal aguda en el enfermo grave. Rev Asoc Mex Med Crit y Ter Int. 2009;23(4):241-4.
- Naruka V, Mckie MA, Khushiwai R, Clayton J, Aresu G, Peryt A, et al. Acute kidney injury after thoracic surgery a proposal for a multicentre evaluation (MERITS) Interact CardioVasc Thorac Surg. 2019;29(6):861-6. DOI: https://doi.org/10.1093/icvts/ivz184
- Cardinale D, Cosentino N, Moltrasio M, Sandri M.T, Petrella F, Colombo A, et al. Acute Kidney injury after lung cancer surgery Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide, Lung Cancer. 2018;123(9):155-9. DOI: https://doi.org/10.1016/j.lungcan.2018.07.009
- Espuña Pons M, Puig Clota M, Rebollo Álvarez P. Validación de la versión en español del “Cuestionario de Autoevaluación del Control de Vejiga” (CACV). Un nuevo instrumento para detectar pacientes con disfunción del tracto inferior. Actas Urol Esp. 2006;30(10):1017-24. DOI: https://doi.org/10.1016/S0210-4806(06)73578-1
- Kelly CE. Evaluation of voiding dysfunction and measurement of bladder volume. Rev Urol. 2004;6(1):32-7.
- Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatients surgery. Anesth Analg. 1999;89(1):90-7. DOI: https://doi.org/10.1213/00000539-199907000-00016
References
Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101(3):172-88. DOI: https://doi.org/10.1002/bjs.9394
Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERASVR ) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91-115. DOI: https://doi.org/10.1093/ejcts/ezy301
Wind J, Polle SW, Fung Kon Jin PHP, Dejonj CHC, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800-9. DOI: https://doi.org/10.1002/bjs.5384
Puckett JR, Pickering JW, Palmer SC, McCall JL, Kluger MT, De Zoysa J, et al. Low versus standard urine output targets in patients undergoing major abdominal surgery: a randomized noninferiority trial. Ann Surg. 2017;265(5):874-81. DOI: https://doi.org/10.1097/SLA.0000000000002044
Licker M, Cartier V, Robert J, Diaper J, Villiger Y, Tschopp JM, et al. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery Ann. Thorac. Surg. 2011;91(3):844-50. DOI: https://doi.org/10.1016/j.athoracsur.2010.10.037
Matot I, Dery E, Bulgov Y, Cohen B, Paz J, Nesher N. Fluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function. J Thorac Cardiovasc Surg. 2013;146(2):461-6. DOI: https://doi.org/10.1016/j.jtcvs.2013.02.015
Kim KW, Lee JI, Kim JS, Lee YJ, Choi WJ, Jung H, et al. Risk factors for urinary retention following minor thoracic surgery. Interact CardioVasc Thorac Surg. 2015;20(4):486-92. DOI: https://doi.org/10.1093/icvts/ivu445
Allen MS, Blackmon SH, Nichols FC, Cassivi SD, Harmsen WS, Lechtenberg B, et al. Optimal timing of urinary catheter removal after thoracic operations: a randomized controlled study. Ann Thorac Surg. 2016;102(3):925-30. DOI: https://doi.org/10.1016/j.athoracsur.2016.03.115
Egal M, de Geus HR, van Bommel J, Groeneveld AB. Targeting oliguria reversal in perioperative restrictive fluid management does not influence the occurrence of renal dysfunction: a systematic review and meta-analysis. Eur J Anaesthesiol. 2016;33(6):425-35. DOI: https://doi.org/10.1097/EJA.0000000000000416
Carrillo Esper R, Castro Padilla JF. Escala RIFLE. Fundamentos y su impacto en el diagnóstico, pronóstico y manejo de la lesión renal aguda en el enfermo grave. Rev Asoc Mex Med Crit y Ter Int. 2009;23(4):241-4.
Naruka V, Mckie MA, Khushiwai R, Clayton J, Aresu G, Peryt A, et al. Acute kidney injury after thoracic surgery a proposal for a multicentre evaluation (MERITS) Interact CardioVasc Thorac Surg. 2019;29(6):861-6. DOI: https://doi.org/10.1093/icvts/ivz184
Cardinale D, Cosentino N, Moltrasio M, Sandri M.T, Petrella F, Colombo A, et al. Acute Kidney injury after lung cancer surgery Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide, Lung Cancer. 2018;123(9):155-9. DOI: https://doi.org/10.1016/j.lungcan.2018.07.009
Espuña Pons M, Puig Clota M, Rebollo Álvarez P. Validación de la versión en español del “Cuestionario de Autoevaluación del Control de Vejiga” (CACV). Un nuevo instrumento para detectar pacientes con disfunción del tracto inferior. Actas Urol Esp. 2006;30(10):1017-24. DOI: https://doi.org/10.1016/S0210-4806(06)73578-1
Kelly CE. Evaluation of voiding dysfunction and measurement of bladder volume. Rev Urol. 2004;6(1):32-7.
Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatients surgery. Anesth Analg. 1999;89(1):90-7. DOI: https://doi.org/10.1213/00000539-199907000-00016