Kvalitetsarbete vid akut höftledsfraktur kunde begränsa njurpåverkan. Reviderat vårdprogram minskade incidensen från 23 till 4 procent
Sammanfattning
An internal investigation revealed that kidney injury (rise in serum creatinine by 50% or more) developed in 23% of the 86 patients who underwent acute hip fracture surgery at Södertälje Hospital between January and August 2012. The key factor correlating to kidney injury was a large surgical haemorrhage (mean 600 ml versus 300 ml for those without kidney injury). Due to the high incidence of kidney problems, several modifications of the hospital care program for this patient group were soon initiated. The changes included a standardised fluid program with more ambitious preoperative hydration while starch solutions were discontinued. The hospital also introduced goal-directed diuresis and standardized the transfusion trigger (100 g/l) as well as monitoring of the anaesthesia. A follow-up 5 months later included 71 patients, and the incidence of kidney injury had then been reduced to only 4%.