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· DOS Abstracts
Patient safe pain management of acute hip fracture
patients requires focus on the kidney function
Morten Baltzer Andersen, Beata Malmqvist, Henrik Palm
Department of Orthopaedic Surgery & The Hospital Pharmacy, Copenhagen
University Hospital Hvidovre, Denmark; Department of Orthopaedic Surgery,
Copenhagen University Hospital Hvidovre, Denmark
Background:
Standard medical treatment including painkillers are often used
for hip fracture patients in Denmark. Painkillers and the frequent co-morbidity
Chronic Kidney Disease (CKD) are a known as risk factors for the serious com-
plication including Acute Kidney Injury (AKI). AKI are often reversible but in-
crease mortality and hospitalization.
Purpose / Aim of Study:
The purpose was to identify the amount of CKD, AKI
and use of painkillers among hip fracture patients.
Materials and Methods:
202 consecutive hip fracture patients (71% female,
mean age 78 (range 22- 97)) admitted through the ER from Sept 2012 to
March 2013 were included. Painkillers were defined as NSAID and/or Morphine,
both included in our standard medicine package. The patient’s upper and lower
estimated Glomerular Filtration Rate (eGFR) was recorded between admission
and discharge. The stage of CKD was based on the patients’ highest eGFR dur-
ing hospitalization and the AKI definition was based on the eGFR change by the
RIFLE (R-risk, I-Injury, F- failure, L-loss, E-end stage) classification.
Findings / Results:
91 (45%) patients had a normal kidney function, while it
was reduced mildly in 69 (34%), moderately in 38 (20%), severe in 3 (1%) and
a single patient had terminal renal insufficiency. AKI occurred in 20 cases (10%)
and patients with reduced kidney function had four times greater risk of devel-
oping AKI (p=0.02). Among these cases, use of NSAID was not stopped in 8 and
oral Morphine in 7 of the 20 patients after they had developed AKI.
Conclusions:
Use of standardized prescribed painkillers appear secure for 90%
of hip fracture patients. However, as half of the patients have reduced kidney
function and thereby increased risk of AKI, continued focus on kidney function
seems necessary for increasing patient safety.
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