Implementation of a Multidisciplinary Guideline to Reduce Post-operative Acute Kidney Injury in Elective Surgical Patients: A Quality Improvement Study

TL;DR

A multidisciplinary guideline to reduce post-operative kidney injury in elective surgery patients was implemented, leading to fewer dialysis needs and shorter hospital stays.

Contribution

A comprehensive multidisciplinary guideline and risk assessment tool were implemented to reduce post-operative acute kidney injury.

Findings

The POST cohort had lower mortality and shorter hospital, ICU, and ventilator stays compared to the PRE cohort.

The POST group showed a significant reduction in acute kidney injury incidence after guideline implementation.

Abstract

Introduction

Post-operative acute kidney injury (AKI) has a significant impact on patients and healthcare systems. We studied the impact of the implementation of a comprehensive multidisciplinary guideline and risk assessment tool on the need for dialysis and hospital length of stay (LOS) in patients undergoing elective surgery.

Methods

We performed a single-center retrospective analysis of patients undergoing elective surgery before and after the implementation of a comprehensive multidisciplinary guideline for decreasing post-operative AKI from January 2021 to August 2024. The guideline utilized a pre-operative risk assessment tool to predict patients at high risk for post-operative AKI and utilized intra-operative and perioperative interventions to improve perfusion and volume status. Patients were categorized into pre (PRE) - January 2021 to May 2021, and post-implementation (POST) - June 2023 to August 2024, cohorts. The primary outcome was the need for dialysis. Secondary outcomes were mortality, hospital LOS, ICU LOS, and ventilator days.

Results

Of the 11,006 patient visits, 7,398 (67%) were in the PRE period, and 3,608 (33%) were in the POST period. The POST group was older (age in years POST: 63.9 vs. PRE: 62.9) and had a lower incidence of CAD (POST: 21.2% vs. PRE: 25.9%) and hypertension (POST: 47.5% vs. PRE: 52.8%). After matching, the POST group had longer procedure times and higher intra-operative fluids, and the distribution of surgical specialties was different. The POST had lower mortality (0.5% vs 1.0%, p=0.04) and shorter LOS in the hospital (median: three vs four days), in the ICU (eight vs nine days), and on the ventilator (one vs two days). In the multivariable regression analysis, the POST cohort was significantly associated with a reduction in AKI incidence (OR: 0.83, 95% CI: 0.69, 0.99; p = 0.04).

Conclusion

Implementing a multidisciplinary process to improve post-operative AKI may improve AKI and hospital LOS. Targeted interventions to reduce AKI should be further examined.

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