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. 2019 Aug 20;8(8):1265.
doi: 10.3390/jcm8081265.

Does the Implementation of a Quality Improvement Care Bundle Reduce the Incidence of Acute Kidney Injury in Patients Undergoing Emergency Laparotomy?

James F Doyle  1   2 , Alexander Sarnowski  1 , Farzad Saadat  1 , Theophilus L Samuels  3 , Sam Huddart  1 , Nial Quiney  1 , Matthew C Dickinson  1 , Bruce McCormick  4 , Robert deBrunner  4 , Jeremy Preece  4 , Michael Swart  5 , Carol J Peden  6 , Sarah Richards  7 , Lui G Forni  8   9
Affiliations

Does the Implementation of a Quality Improvement Care Bundle Reduce the Incidence of Acute Kidney Injury in Patients Undergoing Emergency Laparotomy?

James F Doyle et al. J Clin Med. .

Abstract

Purpose: Previous work has demonstrated a survival improvement following the introduction of an enhanced recovery protocol in patients undergoing emergency laparotomy (the emergency laparotomy pathway quality improvement care (ELPQuiC) bundle). Implementation of this bundle increased the use of intra-operative goal directed fluid therapy and ICU admission, both evidence-based strategies recommended to improve kidney outcomes. The aim of this study was to determine if the observed mortality benefit could be explained by a difference in the incidence of AKI pre- and post-implementation of the protocol.

Method: The primary outcome was the incidence of AKI in the pre- and post-ELPQuiC bundle patient population in four acute trusts in the United Kingdom. Secondary outcomes included the KDIGO stage specific incidence of AKI. Serum creatinine values were obtained retrospectively at baseline, in the post-operative period and the maximum recorded creatinine between day 1 and day 30 were obtained.

Results: A total of 303 patients pre-ELPQuiC bundle and 426 patients post-ELPQuiC bundle implementation were identified across the four centres. The overall AKI incidence was 18.4% in the pre-bundle group versus 19.8% in the post bundle group p = 0.653. No significant differences were observed between the groups.

Conclusions: Despite this multi-centre cohort study demonstrating an overall survival benefit, implementation of the quality improvement care bundle did not affect the incidence of AKI.

Keywords: acute kidney injury; emergency surgery; enhanced recovery; goal directed therapy; laparotomy; post-operative complications.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Cumulative P-POSSUM scores pre- and post-ELPQuiC implementation—circle represents the mean value.
Figure 2
Figure 2
Four-fold Plot. Incidence of AKI day 1 post-op.
Figure 3
Figure 3
Four-fold Pl–t. Incidence of maximum AKI obtained between day 1 and day 30 post-op.
Figure 4
Figure 4
Cumulative AKI incidence (A) Day 1, (B) Max (day1-day30) and (C) Day 30 post-op pre and post-ELPQuiC implementation:
Figure 5
Figure 5
Incidence of 30-day mortality.
Figure 6
Figure 6
Centre specific 30-day mortality data.
Figure 7
Figure 7
Cumulative 30-day mortality data.
See this image and copyright information in PMC

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