Ashford and St Peter's Hospitals NHS Foundation Trust

5. Ms S complains about aspects of care her father, Mr S, received from Ashford and St Peter’s Hospitals NHS Foundation Trust (the Trust) in December 2024. Specifically, she complains the Trust:

• did not inform them of the risks of pharyngitis during her father’s hernia surgery, and • administered antibiotics during his surgery which caused him an acute kidney injury (AKI) which led to an urgent accident and emergency (A&E) admission.

6. As a result of these failings, Ms S says her father’s physical health has been affected. She explains he has suffered an acute kidney injury and has been diagnosed with stage 4 kidney disease. She says her father is now unable to care for her mother, and she is unable to work as she has to look after both her parents.

7. Ms S says her father has to attend appointments which have cost hundreds of pounds in taxis to attend, and her mother was unable to attend her dementia day care centre. She says as her parent’s carer she has to provide full personal care to them, including a full change in her father’s diet due to the condition he has developed.

8. As an outcome to her complaint, Ms S seeks an acknowledgement of failings which have led to a change in her father’s life, service improvements and a financial remedy of over £12,500.

9. On 4 December, Mr S underwent a right inguinal hernia surgery. This is where a hernia (a bulge of tissue or part of the bowel through a weak spot in the abdomen wall) is repaired using a mesh. Mesh is a thin sheet of material to strengthen the weakened area.

10. On 28 December, Mr S attended A&E because he has a sore throat and bloating. He was diagnosed with pharyngitis, which is an inflammation of the pharynx (throat) resulting in a sore throat.

11. Staff prescribed him a five-day course of co-amoxiclav antibiotics for a suspected throat infection. Staff also found he had stage 2 acute kidney injury but as his condition improved, staff discharged him on 30 December.

12. In March 2025, Mr S became increasingly unwell and underwent an urgent kidney biopsy. He was then diagnosed with tubulointerstitial nephritis (antibiotic induced acute kidney injury) and stage 4 chronic kidney disease. Sadly, Mr S’s condition continued to deteriorate and now has a shortened life expectancy.

16. Before we decide if we should investigate a complaint in more detail we look at whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, this indicates a failing.

Pharyngitis

17. Ms S says the Trust did not properly inform her or her father about the risk of pharyngitis as a side effect from being intubated. She says a few weeks after the operation, she had to bring her father to A&E because he was complaining of a sore throat and bloating. Here he was diagnosed with pharyngitis (sore throat).

18. We understand this would have been a difficult time for Mr S as he was in pain following the surgery. We also understand this would have caused distress to Ms S to witness her father in pain.

19. On 4 December, Mr S underwent a right inguinal hernia surgery where he was intubated. This meant he had a tube down his throat to help him breathe while under general anaesthesia for his surgery. After his surgery, Mr S’ condition improved and he was discharged home.

20. Mr S did not complain about having a sore throat straight after surgery. Several weeks later, Mr S developed a sore throat. He attended A&E for this, and staff diagnosed him with pharyngitis.

21. Mr S’s medical records show staff discussed the upcoming surgery with Mr S during a virtual appointment. Ms S raised questions about side effects on her father’s behalf. The clinic letter from this appointment shows full discussion was had regarding the potential side effects from the operation including Mr S potentially suffering from a sore throat straight after the procedure.

22. Our anaesthesia adviser explains that when someone is given a general anaesthetic, extra care needs to be taken to lower the risk of pulmonary aspiration. This is when stomach contents accidentally go into the lungs. If this happens, it can cause serious problems like infection or breathing difficulties.

23. The anaesthesia risk article and anaesthetic guide contain a list of risk factors for aspiration, which include diabetes and chronic kidney disease, hiatus hernia (where part of the stomach pushes up through an opening in the diaphragm and into the chest) and recurrent regurgitation (reflux). It explains a way of reducing this risk is intubation during surgery.

24. Our anaesthesia adviser said Mr S had a history of gastric reflux and hiatus hernia meaning he was at a high risk of aspiration. As a result, intubating Mr S during his surgery was appropriate as it helped protect his airway and reduced the risk of aspiration. This is in line with accepted practice on airway management as mentioned above.

25. The anaesthesia infographic lists identifies sore throat or pharyngitis as a recognised side effect of intubation, affecting approximately 20% to 40% of patients who undergo intubation. This normally occurs soon after the procedure.

26. The anaesthetic record shows intubation was straightforward, with no evidence of trauma or complication. After the procedure Mr S was eating and drinking normally too, with no reported throat symptoms. When Mr S reported a sore throat, he described symptoms starting approximately 19 days after the surgery. This strongly indicates his sore throat was not due to being intubated.

27. We acknowledge the distress caused to Mr S. However, a sore throat is a recognised side effect of intubation under anaesthesia and in this case, it appears unlikely to be the cause of Mr S’s sore throat. In any case, we would like to reassure Ms S that the procedure was carried out appropriately, without complication, and that these risks were discussed with her and her father prior to the surgery. On this basis, we find the Trust acted in line with expected guidance and standards.

Antibiotics

28. Ms S says the antibiotics prescribed to Mr S by the Trust caused him to become increasingly unwell and he had to undergo an urgent kidney biopsy. Ms S says her father was then diagnosed with tubulointerstitial nephritis, presumed antibiotic related (antibiotic induced acute kidney injury) and stage 4 chronic kidney disease.

29. Ms S is concerned her father now has stage 5 chronic kidney disease and has a life expectancy of six to 24 months. She believes this was because of the antibiotic he was prescribed, co-amoxiclav.

30. The records show Mr S has a range of comorbidities, including IgG4 disease of the bladder and liver, which is a chronic autoimmune condition where the immune system attacks multiple organs causing inflammation. Mr S was on immunosuppression medication prior to his surgery, and the records note Mr S developed urinary retention (when the bladder does not fully empty) during the surgery. Our nephrology adviser says this can contribute to an acute kidney injury.

31. The cirrhosis article and the acute kidney injury guidance also say a background of kidney disease reduces kidney reserve and makes it more prone to injury. We can see Mr S already had an acute kidney injury from 2024 and was under the care of urology prior to his operation.

32. The acute kidney injury guidance says when assessing the risk of an acute kidney injury, investigations should be made if any of the following are present or likely to be present, liver disease and diabetes. Mr S sadly already had these diagnoses therefore was more prone to acute kidney injury.

33. Staff prescribed Mr S co-amoxiclav which is a very commonly used antibiotic. The antibiotics were prescribed to treat a suspected infection, which our nephrologist adviser says is consistent with accepted clinical practice. The AIN summary confirms this can, in some cases, be linked to a kidney inflammation called acute tubulointerstitial nephritis (ATIN), which may lead to acute kidney injury. This risk can occur with many medicines. In Mr S’s case, this is only a possible association, as his other risk factors as mentioned above make it more likely to have caused his kidney injury.

34. The ATIN article also says the prognosis of acute kidney injury depends on the baseline kidney status and the level of damage or harm caused, or sometimes a hypersensitive reaction. Our nephrologist adviser said the background kidney damage as evident on Mr S’s biopsy report suggests that he had chronic damage which can make kidneys more vulnerable to permanent damage.

35. The evidence above shows acute kidney injury can be caused by certain medications, including antibiotics. The biopsy findings are consistent with drug-related inflammation of the kidneys. However, they do not identify a specific drug as the cause.

36. We have also considered Mr S’s wider clinical picture. The records show he had several established risk factors for acute kidney injury, including chronic kidney disease, liver cirrhosis, recent surgery and exposure to multiple medications during his care.

37. In these circumstances, acute kidney injury is commonly the result of a combination of factors rather than a single cause. This means it is not possible to attribute the injury to one medication without clear supporting evidence.

38. While antibiotics such as co-amoxiclav are known to carry the risk of kidney injury, the available evidence does not show that they were the more likely cause in this case when considered alongside the other significant risk factors. Independent clinical advice supports this view and confirms Mr S’s acute kidney injury is likely to have been multifactorial.

39. On the balance of probabilities, and taking account of the multiple contributing factors, we find that the antibiotics were unlikely to have caused Mr S’s acute kidney injury.

Conclusion

40. We have considered all of the evidence, including the clinical records, relevant guidance and independent clinical advice, as well as Ms S’s concerns.

41. For the pharyngitis, the evidence shows care was appropriate. Intubation was clinically necessary, and a sore throat is a recognised side effect. The records indicate relevant risks were discussed as part of the consent process. The Trust acted in line with relevant guidance and standards.

42. For the acute kidney injury, we recognise that certain antibiotics can cause kidney injury. However, the evidence indicate Mr S had significant risk factors, and his condition is likely to have been multifactorial. We are unable to conclude, on the balance of probabilities, that the antibiotics prescribed were the cause of his acute kidney injury. The decision to prescribe antibiotics was appropriate.

43. While we acknowledge the distress experienced by Mr S and his family, the evidence does not show the Trust acted outside of accepted standards of care.

44. We thank Ms S for taking the time to bring her complaint to our attention. We hope our explanation brings some reassurance about the care and treatment her father received.

1. We have carefully considered Ms S’s complaint about the care and treatment her father, Mr S, received from Ashford and St Peter's Hospitals NHS Foundation Trust (the Trust).

2. We are very sorry to hear of the distress caused to Mr S and Ms S following the operation at the Trust in December 2024. We are grateful for Ms S’s time in bringing this complaint to our attention.

3. Having carefully considered her complaint, we would like to reassure Ms S we have not seen indications the Trust failed to provide adequate information about potential side effects of intubation during anaesthesia.

4. Additionally, we cannot say on the balance of probabilities that the antibiotic administered to Mr S during his operation was the cause of his acute kidney injury. We recognise this was a very difficult time for Ms S and her family. We hope our explanation below reassures Ms S we have looked into her complaint carefully.