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

Doyle, James F., Sarnowski, Alexander, Saadat, Farzad, Samuels, Theophilus L., Huddart, Sam, Quiney, Nial, Dickinson, Matthew C., McCormick, Bruce, deBrunner, Robert, Preece, Jeremy , Swart, Michael, Peden, Carol J., Richards, Sarah and Forni, Lui G. (2019) Does the Implementation of a Quality Improvement Care Bundle Reduce the Incidence of Acute Kidney Injury in Patients Undergoing Emergency Laparotomy? Journal of Clinical Medicine, 8 (8).

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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 dfference 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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Doyle, James F.
Sarnowski, Alexander
Saadat, Farzad
Samuels, Theophilus L.
Huddart, Sam
Quiney, Nial
Dickinson, Matthew C.
McCormick, Bruce
deBrunner, Robert
Preece, Jeremy
Swart, Michael
Peden, Carol J.
Richards, Sarah
Forni, Lui
Date : 20 August 2019
DOI : 10.3390/jcm8081265
Copyright Disclaimer : © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
Uncontrolled Keywords : Post-operative complications; Acute kidney injury; Enhanced recovery; Goal directed therapy; Emergency surgery; Laparotomy
Additional Information : The ELPQuiC Collaborator Group was formed from four acute hospital trusts in England. The group is grateful to the hard-working staff in all these hospitals who were able to implement the ELPQuiC bundle so effectively. Funding from the Health Foundation was provided to all hospitals (Shine Grant 2012). Baseline data collection at the Royal United Hospital Bath was funded by an Innovation grant from the South West Strategic Health Authority. LiDCO Group (London, UK) provided LiDCO rapid cardiac output monitors, consumables and education at all sites, depending on local experience and requirements. LiDCO Group was not involved in any project discussions, protocol design, meetings or data analysis.
Depositing User : Diane Maxfield
Date Deposited : 29 Oct 2019 11:03
Last Modified : 29 Oct 2019 11:04

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