Thursday, 11 November 2010

An age old problem

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on “Elective & Emergency Surgery in the Elderly: An Age Old Problem (2010)” was published this morning and widely reported in the media.

It asks the question “how good is care in the elderly who undergo surgery?”; only a third of the over 80s receive good care!!

Frailty, poor nutrition and memory impairment are frequently missed. Co-morbidity in polypharmacy are common. Unnecessary delays occur. Pain is poorly managed. Access to higher levels of care is under utilised. No consultant review between admission and surgery was found in the notes of almost 50% of patients.

Shocking! But it also sounds familiar to those who have read Acute Kidney Injury: Adding Insult to Injury.

What about acute kidney injury in the elderly surgical patient? Common; 36% developed AKI during admission. Harmful; all these patients died. Treatable; 50% had no record of pre-operative hydration status; 40% had no record of urine output pre-operatively. Only 63% had intra-operative fluid input recorded.

“Post operative AKI was related to poor intra-operative management of fluids and cardiovascular status and was compounded by deficiencies in post-operative management”.

Post-operative AKI is avoidable in the elderly and should not occur. There is a need for continuous post graduate education of physicians, surgeons and anaesthetists around the measurement of risk factors for the development of AKI in the elderly surgical patient.

There should be clear strategies for the management of intra-operative low blood pressure in the elderly to avoid cardiac and renal complications.

When to start? No better time than patient safety week, 15-21 November 2010. Take a look; one of the major aims of the week this year is to improve hydration for hospital inpatients. Patient Safety First’s cause “make the safety of patients everyone’s highest priority” and aim “no avoidable death and no avoidable harm”.

A cause and aim to which we should all strive.

NCEPOD Press Release 11 November 2010