Insertion of a Urinary Catheter on Admission Lowers Acute Kidney Injury Incidence following Hip Fractures
2Medical School, Bar Ilan University, ישראל
3Dept. of Nephrology, Rabin Medical Center, ישראל
4Medical School, Tel-Aviv University, ישראל
Hip fracture patients are a high-risk population for developing peri-operative Acute Kidney Injury (AKI). Close monitoring of blood pressure and hydration status, reducing nephrotoxic medications and prevention of urinary retention are essential preventive measures.
In recent years the magnitude of AKI incidence in hip fracture patients and it’s significant impact on morbidity and mortality in this patient group has been established.
Aim:
To determine if routine insertion of a urinary catheter on admission in patients suffering from a hip fracture will reduce the incidence of AKI.
Population and methods:
250 consecutive patients, 65 years old and over, who presented with a hip fracture between February 2018- May 2019 were included. According to alternate admission days, a urinary catheter was either routinely inserted upon admission/before surgery in one group (“catheter group”) or as needed postoperatively/not at all in the other group (“non-catheter group”). Data was retrospectively collected from the electronic health records.
Results:
122/250 patients (48.8%) were included in the catheter group. Overall AKI incidence was 11.6% (29/250). The catheter group had a significantly lower rate of AKI with a 6.6% incidence compared to 16.4% in the non-catheter group (p=0.018). After a 25 month follow-up period, the overall mortality was 10.8% (27/250). In-hospital mortality was 7.4% (2/27), Short-term mortality (within 30 days after discharge) was 7.4% (2/27) and long-term (30 days to 1 year after discharge) mortality was 85.8% (23/27) of all deaths. All cases of in-hospital mortality occurred within the AKI group. Patients with no AKI had a better survival rate but this difference was not statistically significant (p=0.21). Mortality rate in the catheter group was 8.2% compared with 13.8% in the non-catheter group (p =0.225).
Conclusions:
Perioperative AKI was associated with higher rates of postoperative complications and worse survival rate. Insertion of a urinary catheter upon admission or before surgery significantly reduced AKI incidence.