Acute Kidney Injury Post Hip Fracture Surgery: Local Quality Improvement Project and Review of Literature

The aim of the study is to identify the potential risk factors for postoperative AKI in hip fracture patients.

Using our local neck of femur (NOF) registration data, patient details were selected using inclusion and exclusion criteria. Electronic records of patients were assessed retrospectively, including blood results, radiological investigations, clinical documentation, and drug charts. The time period was from the start of January 2022 to the end of June 2022.

All patients > 50 years old with NOF fractures underwent operative management from January 2022 to June 2022.

1. Pathological fractures. 2. Non-operative management. 3. Died directly postoperative.

Two hundred and fifty patients underwent hip fracture surgery at our hospital in 6 months (January 2022-June 2022) (Cemented procedures were 133 [53%], while fixation procedures were 117 [47%]). Female patients were 174 (70%), and male patients were 76. The average age was 83.4 years, and the number of operations done over the weekend (Friday-Sunday) = 123 (49%). The incidence of postoperative AKI was 56 (22.4%). Forty-five of the fifty-six cases were stage one (80.4%), while seven cases (12.5%) were stage 2. The studied risk factors for postoperative AKI were cemented procedures (61% of postoperative AKI incidence), female gender (66%), time from admission to operation (>24 hours = 33%), day of operation (operations done Friday/Saturday/Sunday = 55%), and postoperative antibiotics (71%).

We need strategies to reduce the incidence of postoperative AKI, like AKI alert on laboratory results, IV fluid prescription preoperatively since the arrival of patients to the ED, avoiding/stopping nephrotoxic medications on admission, regular review of postoperative renal function tests and fluid balance, especially in high-risk patients, increase nursing staff and junior doctors on wards over weekends, and we need to review our policy of giving postoperative IV antibiotics.