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- Talk
- 08/07/2022
- UK
The Incidence of Post–Operative Acute Kidney Injury in Trauma and Orthopaedic Patients Across an NHS Trust
Description
In this presentation, Dr. Sanat Kulkarni, a junior doctor from Birmingham, discusses an innovative study focusing on the reduction of post-operative acute kidney injury (AKI) in trauma and orthopaedic (T&O) patients. The rationale behind this study is rooted in the understanding that post-operative AKI not only elevates the risk of further complications but also extends hospital stays and increases rates of morbidity and mortality. Dr. Kulkarni shares insight into the comprehensive approach taken within their department to address this issue over several years, including the collection of data across three different six-month cycles from 2017 to 2020.
The study involved analyzing patients who underwent either elective or emergency surgeries, identifying those who developed AKI, and gathering demographic and clinical data, such as age and the use of nephrotoxic medications. Initial interventions included modifications to the Enhanced Recovery After Surgery (ERAS) protocol, improved education for junior doctors on fluid management, and a review of pre- and post-operative medications. However, these first measures did not yield the desired outcomes, prompting the implementation of more intensive strategies, such as close collaboration with the orthogeriatric team for risk assessment and optimizing care for high-risk patients.
The results showed a significant decrease in AKI incidence from 4.3% to 2%, five times lower than the national average. A notable reduction in nephrotoxic medication prescriptions supported the finding that their interventions effectively contributed to the improved outcomes. Furthermore, the severity of AKI cases became milder, with more patients experiencing Stage 1 AKI, which generally has a better prognosis. Follow-up analyses confirmed that patients with post-operative AKI experienced longer hospital stays and higher one-year mortality rates.
An economic analysis suggested that the department could save substantial costs annually as a result of these interventions. Dr. Kulkarni concludes with a strong emphasis on the importance of utilizing straightforward perioperative measures to enhance patient outcomes while also benefiting hospital finances.