# Role of Enhanced Recovery After Surgery (ERAS) Protocols in Preventing Postoperative Acute Kidney Injury (AKI)

## TL;DR

This study finds that using ERAS protocols during surgery significantly reduces the risk of acute kidney injury and shortens hospital stays.

## Contribution

The study demonstrates that ERAS protocols can serve as a renal-protective strategy in major elective surgery.

## Key findings

- ERAS adherence was associated with a 44% lower odds of postoperative AKI compared to conventional care.
- Patients receiving ERAS had shorter hospital stays and fewer ICU admissions.
- Positive fluid balance, low baseline eGFR, and intraoperative hypotension were independent risk factors for AKI.

## Abstract

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.