Crystal Koerner Wins Best Resident Abstract Award at ACS-Georgia Chapter Annual Meeting

August 2018

Emory Surgery PGY-4 resident Crystal Koerner, MD, won the General Surgery Resident Abstract Competition at the Georgia Chapter of the American College of Surgeons' Annual Meeting, held August 17 though 19 on St. Simons Island, GA.

Her Emory co-authors included Glen Balch, MD, Virginia Shaffer, MD, and Patrick Sullivan, MD, of the Division of Colorectal Surgery; Charles Staley, MD, chief of the Division of Surgical Oncology; Shishir Maithel, MD, who leads surgical oncology's translational research program; Jahnavi Srinivasan, MD, associate program director of the Emory general surgery residency; former research sabbatical resident and current PGY-3 Alexandra Lopez-Aguiar, MD; and Mohammad Zaidi, PhD, a postdoctoral research fellow in Dr. Maithel's lab.

The study focused on assessing the association of Enhanced Recovery after Surgery protocols (ERAS) with the incidence and severity of acute kidney injury (AKI) in patients undergoing elective colorectal surgery. AKI, a common perioperative complication, is associated with significant morbidity and mortality. Hydration is considered a suitable strategy for guarding against AKI, but minimizing perioperative fluid administration is a key component of ERAS, creating a potential conflict that Dr. Koerner and her team hoped to clarify further.

The team retrospectively reviewed ERAS and non-ERAS managed patients who underwent colorectal surgery between 2013 through 2017, with the primary endpoint being postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission.

Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS vs non-ERAS patients (23 vs 9%). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors, more complex colorectal operations, and management with an ERAS pathway.

On multivariable analysis, ERAS remained a significant risk factor for developing AKI. ERAS patients had a shorter LOS compared to non-ERAS patients, with no difference in 30-day readmission rates.

Dr. Koerner and her collaborators concluded that although the incidence of AKI was higher in patients treated with ERAS protocols, the majority represented minor elevations in baseline serum creatinine and did not affect the reduction in LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, they recommended that ERAS protocols be optimized to prevent postoperative AKI.