Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients : a quality improvement project
Author
Kulkarni, SanatRichardson, Thomas
Green, Alice
Acharya, Radhika
Latif, Arusa
Johnson, Dakota
Naqvi, Huma
Gella, Sreenadh
Affiliation
Sandwell and West Birmingham NHS Trust; University of BirminghamPublication date
2023-03
Metadata
Show full item recordAbstract
Background: Acute kidney injury (AKI) is a common postoperative complication which increases morbidity and mortality. This quality improvement project aimed to implement measures targeting known risk factors to decrease the incidence of postoperative AKI in trauma and orthopaedics (T&O) patients. Methods: Data were collected across three six-month to 7-month cycles between 2017 and 2020, analysing all elective and emergency T&O operated patients within a single NHS Trust (n=714, 1008 and 928, respectively). Patients who developed a postoperative AKI were identified using biochemical criteria and data were collected on known AKI risk factors, including use of nephrotoxic medications, and patient outcomes. In the final cycle, the same variables were collected for patients without AKI. Between cycles, measures implemented included: preoperative and postoperative medication reconciliation aiming to stop nephrotoxic medications, orthogeriatrician review of high-risk patients and junior doctor teaching on fluid therapy. Statistical analysis was undertaken to determine the incidence of postoperative AKI across cycles, prevalence of risk factors and impact on length of hospital stay and postoperative mortality. Results: There was a statistically significant decrease in postoperative AKI incidence from 4.27% (43 of 1008 patients) in cycle 2 to 2.05% (19 of 928) in cycle 3 (p=0.006), with a notable decrease in use of nephrotoxic medications. Significant predictors for the development of postoperative AKI included use of diuretics and receiving multiple nephrotoxic drug classes. Development of postoperative AKI significantly increased length of hospital stay by 7.11 days on average (95% CI: 4.84 to 9.38 days, p<0.001) and risk of 1-year postoperative mortality (OR 3.22, 95% CI: 1.03 to 10.55, p=0.046). Conclusion: This project demonstrates that a multifaceted approach targeting modifiable risk factors can reduce incidence of postoperative AKI in T&O patients, which may lead to reduced length of hospital stay and postoperative mortality.Citation
Kulkarni S, Richardson T, Green A, Acharya R, Latif A, Johnson D, Naqvi H, Gella S. Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project. BMJ Open Qual. 2023 Mar;12(1):e002124. doi: 10.1136/bmjoq-2022-002124Type
ArticlePMID
36868574Journal
BMJ Open QualityPublisher
BMJ Publishing Groupae974a485f413a2113503eed53cd6c53
10.1136/bmjoq-2022-002124