Evacuating the need for an integrated geriatric service on the prevalence of acute kidney injury in older general surgery patients
Abeysekera, N and Mich, C and Mahoney, A and Abeysekera, A and Macphail, A and Ibrahim, J and Jose, M and Tuner, R, Evacuating the need for an integrated geriatric service on the prevalence of acute kidney injury in older general surgery patients, pp. 41-41. ISSN 1320-5358 (2020) [Conference Extract]
To assess the viability of acute kidney injury (AKI) as a quality indicator
in the care of older patients admitted under General Surgery.
Background: To improve the care of older surgical patients, an
orthogeriatric model of care was developed. Despite the success of this model,
there is a paucity of evidence in acute general surgical disciplines on the
capacity of a similar service to reduce complications.
Method: A retrospective review of the medical records of patients aged
75 years and older admitted under General Surgery as emergency admissions
between the 1st of July 2015 and the 30th of June 2018 at the Royal Hobart
Hospital. Twenty randomly selected cases were reviewed by an expert panel
to assess the preventability of AKI.
Results: Of 314 patients, the most commonly reported diagnosis was small
bowel obstruction. Less than half of all patients underwent a surgical, radiological or endoscopic intervention. There were 32 (10%) cases of AKI;
13 (4%) had pre-hospital and 19 (6%) had inpatient. Diabetes and bowel
ischaemia were over-represented in patients with an AKI, otherwise there
was no significant difference between the two groups. Patients with an AKI
were significantly more likely to die, to require an unplanned ICU admission,
and less likely to return to their original residence. Overall, the expert panel
agreed that the development of an AKI was foreseeable and mitigable.
Conclusion: Our patients presented with diagnoses that often did not require
surgical intervention but not infrequently experienced medical complications.
These patients may benefit from a shared model of care and AKI could be a
useful indicator to measure the efficiency of this service