Acute Kidney Injury Post Hip Fracture Surgery: Local Quality Improvement Project and Review of Literature

Arsany Metry; Nauman Manzoor; Ahmed Elkilany; Kanishka Wattage; Arnab Sain; Fahad Hussain; Kerollos Khilla; Zain Sohail; Ali Abdulkarim

doi:10.7759/cureus.75594

Acute Kidney Injury Post Hip Fracture Surgery: Local Quality Improvement Project and Review of Literature

Cureus. 2024 Dec 12;16(12):e75594. doi: 10.7759/cureus.75594. eCollection 2024 Dec.

Authors

Arsany Metry¹, Nauman Manzoor¹, Ahmed Elkilany², Kanishka Wattage¹, Arnab Sain¹, Fahad Hussain¹, Kerollos Khilla³, Zain Sohail¹, Ali Abdulkarim¹

Affiliations

¹ Trauma and Orthopaedics, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Sussex, GBR.
² General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Sussex, GBR.
³ Trauma and Orthopaedics, St. Mary's Hospital, Isle of Wight National Health Service (NHS) Trust, Isle of Wight, GBR.

Abstract

Background: The aim of the study is to identify the potential risk factors for postoperative AKI in hip fracture patients.

Design and methods: Using our local neck of femur (NOF) registration data, patient details were selected using inclusion and exclusion criteria. Electronic records of patients were assessed retrospectively, including blood results, radiological investigations, clinical documentation, and drug charts. The time period was from the start of January 2022 to the end of June 2022.

Inclusion criteria: All patients > 50 years old with NOF fractures underwent operative management from January 2022 to June 2022.

Exclusion criteria: 1. Pathological fractures. 2. Non-operative management. 3. Died directly postoperative.

Results: Two hundred and fifty patients underwent hip fracture surgery at our hospital in 6 months (January 2022-June 2022) (Cemented procedures were 133 [53%], while fixation procedures were 117 [47%]). Female patients were 174 (70%), and male patients were 76. The average age was 83.4 years, and the number of operations done over the weekend (Friday-Sunday) = 123 (49%). The incidence of postoperative AKI was 56 (22.4%). Forty-five of the fifty-six cases were stage one (80.4%), while seven cases (12.5%) were stage 2. The studied risk factors for postoperative AKI were cemented procedures (61% of postoperative AKI incidence), female gender (66%), time from admission to operation (>24 hours = 33%), day of operation (operations done Friday/Saturday/Sunday = 55%), and postoperative antibiotics (71%).

Conclusion: We need strategies to reduce the incidence of postoperative AKI, like AKI alert on laboratory results, IV fluid prescription preoperatively since the arrival of patients to the ED, avoiding/stopping nephrotoxic medications on admission, regular review of postoperative renal function tests and fluid balance, especially in high-risk patients, increase nursing staff and junior doctors on wards over weekends, and we need to review our policy of giving postoperative IV antibiotics.

Keywords: acute kindey injury; antibiotics in joint replacement; care of elderly; complications of cement; hip fractures.