A12(Th)
A NATIONAL AUDIT OF AKI IN ABDOMINAL AORTIC ANEURYSM SURGERY
Hindley, H1, McCleary, J1, Mitchell, D1, Matthews, B2, O’Donoghue, D3
1
Acute Kidney Injury Audit, on behalf of the Vascular Society of Great Britain, Bristol,
2
NHS Kidney Care, London, 3Department of Health, London
OBJECTIVES: Acute Kidney Injury (AKI) is associated with increased mortality following
major surgery. A national study of AKI following Abdominal Aortic Aneurysm (AAA)
Surgery is being undertaken. The dataset includes pre-operative risk factors, operative details
and post-operative function for the first 72 hours or until discharge, using the AKIN
classification. Our aim is to define risk factors for AKI development and to make
recommendations for prevention and care of patients at risk of AKI after AAA surgery.
METHOD/DESIGN: Data collection uses the Vascular Society’s National Vascular
Database (NVD). This web tool allows collection of data in real time from patients
undergoing vascular surgery throughout the UK. The dataset was agreed by a core team
composed of Surgeons, Nephrologists, Anaesthetists and Intensivists and fields additional to
those already within the NVD were added to complete the dataset. Some of the additional
data fields consisted of pre-operative details; statin, asprin, ACEI, ARB, blood tests;
creatinine, sodium, potassium, urea, albumin, operative details; position and time of clamp,
division of renal vein, volume of saline given, urine output, FFP, volume of bank and cell
salvaged bloods, post operative details (Day1-3) include; intra-abdominal pressure, total urine
output, lowest 6hr urine output, inotrope infusion, blood tests for creatinine, urea, sodium,
potassium, haemoglobin and the admission and discharge date and time to ICU/HDU. 500
AAA cases containing complete data fields will be collected and then analysed. Data entry
onto the NVD is voluntary, so the team developed a publicity campaign and strategy to chase
missing data points, based on previous successful vascular surgical trials. A structured chase
up strategy was implemented using various communication methods and a staggered
timeframe encouraging the missing data fields to be collected.
RESULTS/FINDINGS: Data entry runs at 29.2% of total AAA cases entered onto the NVD.
Of the 29.2% of cases, 66% (n=326) cases managed to provide all data points voluntarily,
while 34% (n=168) of the cases required intervention from the chase up to ensure completion.
The data collected consists of both Open and Endovascular AAA procedures (1.2:1) and
Elective and Emergency admissions (2.4:1). To date the data has been submitted by >175
vascular surgeons from 76 trusts different trusts through UK. A multivariate analysis will be
carried out following the completion of data collection, to identify cross correlations between
variables. It is anticipated that the findings from this analysis will inform risk factors on a
post-operative basis.
CONCLUSION: This study illustrates some of the challenges in collecting data for national
audits, where data entry is voluntary. Due to voluntary data entry, the field containing details
for Intra-Abdominal Pressure was found to often be incomplete. This will present challenges
in the analysis of this field when correlating with other variables. We have successfully
identified strategies to reduce the rate of missing data enabling data entry rates to better the
outlined time frame for complete data collection. One year follow up outcome data will start
to be collected in the next stage of the data collection process commencing February 2011.
This will allow results from this study to be available summer 2012. National clinical audits
require additional incentives to further improve data entry rates.