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 G
Department of Intensive Care Medicine and Surrey Peri-Operative Anaesthesia and Critical Care Collaborative Research Group (SPACER), Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK.
Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK.
J Clin Med. 2019 Aug 20;8(8):1265. doi: 10.3390/jcm8081265.
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.
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.
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.
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.
先前的研究表明，在接受急诊剖腹手术的患者中引入强化康复方案（急诊剖腹手术路径质量改进护理（ELPQuiC）套餐）后，患者生存率有所提高。实施该套餐增加了术中目标导向液体治疗和重症监护病房（ICU）入院的使用，这两种都是推荐用于改善肾脏预后的循证策略。本研究的目的是确定观察到的死亡率益处是否可以通过该方案实施前后急性肾损伤（AKI）发病率的差异来解释。
主要结局是英国四个急性信托机构中ELPQuiC套餐实施前后患者群体中AKI的发病率。次要结局包括AKI的KDIGO分期特定发病率。回顾性获取基线时、术后血清肌酐值，并获取术后第1天至第30天记录的最高肌酐值。
在四个中心共识别出303例ELPQuiC套餐实施前的患者和426例ELPQuiC套餐实施后的患者。套餐实施前组的总体AKI发病率为18.4%，套餐实施后组为19.8%，p = 0.653。两组之间未观察到显著差异。
尽管这项多中心队列研究显示总体生存有益，但质量改进护理套餐的实施并未影响AKI的发病率。
