Journal of Pediatric Care

Outcomes After Kidney injury in Surgery (OAKS): Protocol for a multicentre, observational cohort study of acute kidney injury following major gastrointestinal and liver surgery

Joint Event on 18^th International Conference on Pediatrics Health & 2^nd Edition of International Conference on Adolescent Health & Medicine
August 06-07, 2018 Madrid, Spain

Ashleigh Draper

Kings College London, UK

Posters & Accepted Abstracts: J Pediatr Care

DOI: 10.21767/2471-805X-C3-012

Abstract

Data focusing on the patterns of AKI following major gastrointestinal surgery could inform quality improvement projects and clinical trials, but there is a lack of reliable evidence. This multicentre study aims to determine the incidence and impact of AKI following major gastrointestinal and liver surgery. Methodology: Prospective, collaborative, multicentre cohort study will includes adults undergoing gastrointestinal resection, liver resection or reversal of ileostomy or colostomy. The primary end point is the incidence of AKI within 7 days of surgery, identified using an adaptation of the National Algorithm for Detecting AKI, based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI guidelines. The 30-day adverse event rate was measured using the Clavien-Dindo scale. Results: Almost 20% of patients nationally do not have a pre-operative creatinine test. Post-operative creatinine testing, and thus indication of renal function demonstrated 98.4% compliance. Nationally, 14 centres have AKI rates above the 95% confidence interval and 2 above the 99.7% confidence interval for AKI rates, and the overall national rate was 13.1%. Using the Clavien-Dindo scoring system, major complication rate was found to be higher in patients who developed AKI, demonstrating it is a significantly associated with morbidity, mortality and cost. Discussion and conclusions: Pre- and post-operative creatinine measurements can be helpful to stratify risk, direct anaesthetic choices, and guide postoperative management. Patients who have developed an AKI are more likely to go on and develop major complications. It is therefore the hope of the authors that this study will define targets for future quality improvement programmes and clinical trials. Identifying risk factors for AKI will allow stratification of patients to prioritise future interventions aimed at enhancing preoperative optimisation and perioperative monitoring.