Mortality and costs associated with acute kidney injury following major elective,non-cardiac surgery |
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| Affiliation: | 1. Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA;2. Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, VA, USA;3. Division of Nephrology, Department of Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA;4. Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA;5. Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA;1. Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America;2. New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, United States of America;1. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;2. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;3. Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;4. Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States of America;5. Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, NY, United States of America;6. Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States of America;1. Department of Anesthesiology & Pain Medicine, Nationwide Children''s Hospital, Columbus, OH, United States of America;2. Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, United States of America;1. Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland;2. Institute of Physiology, University of Zurich, Zurich, Switzerland;3. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA;1. Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA;2. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA;3. Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA;4. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA |
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| Abstract: | ObjectiveThis study evaluated postoperative AKI severity and its relation to short- and long-term patient outcomes.DesignA retrospective, single-center cohort study of patients undergoing surgery from January 2015 to May 2020.SettingAn urban, academic medical center.PatientsAdult patients undergoing elective, non-cardiac surgery at our institution with a postoperative length of stay (LOS) of at least 24 h were included. Patients were included in 1-year mortality analysis if their procedure occurred prior to June 2019.InterventionsNone.MeasurementsPostoperative AKI was identified and staged using the Kidney Disease Improving Global Outcomes definitions. The outcomes analyzed were in-hospital mortality, LOS, total cost of the surgical hospitalization, and 1-year mortality.Main resultsOf the 8887 patients studied, 648 (7.3%) had postoperative AKI. AKI was associated with severity-dependent increases in all outcomes studied. Patients with AKI had rates of in-hospital mortality of 2.0%, 3.8%, and 12.5% for stage 1, 2, and 3 AKI compared to 0.3% for patients without AKI. Mean total costs of the surgical hospitalization were $23,896 (SD $23,736) for patients without AKI compared to $33,042 (SD $27,115), $39,133 (SD $34,006), and $73,216 ($82,290) for patients with stage 1, 2, and 3 AKI, respectively. In the 6729 patients who met inclusion for 1-year mortality analysis, AKI was also associated with 1-year mortality rates of 13.9%, 19.4%, and 22.7% compared to 5.2% for patients without AKI. In multivariate models, stage 1 AKI patients still had a higher probability of 1-year mortality (OR 1.9, 95% CI 1.3–2.6, p < 0.001) in addition to $4391 of additional costs when compared to patients without AKI (95% CI $2498–$6285, p < 0.001).ConclusionsAll stages of postoperative AKI were associated with increased LOS, surgical hospitalization costs, in-hospital mortality, and 1-year mortality. These findings suggest that patients with even a low-grade or stage 1 AKI are at higher risk for short- and long-term complications. |
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