• James F Doyle, Alexander Sarnowski, Farzad Saadat, Theophilus L Samuels, Sam Huddart, Nial Quiney, Matthew C Dickinson, Bruce McCormick, Robert deBrunner, Jeremy Preece, Michael Swart, Carol J Peden, Sarah Richards, and Lui G Forni.
• 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.
• J Clin Med. 2019 Aug 20; 8 (8).

PurposePrevious 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.MethodThe 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.ResultsA 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.ConclusionsDespite this multi-centre cohort study demonstrating an overall survival benefit, implementation of the quality improvement care bundle did not affect the incidence of AKI.

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