INTRODUCTION: Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common yet underappreciated risk factors for adverse perioperative outcomes. We hypothesize that AKI and CKD are associated with similar increases in ninety-day mortality and cost in patients undergoing major vascular surgery.
METHODS: We used multivariable regression analyses to evaluate the associations between acute and chronic kidney disease and incremental ninety-day mortality and hospital cost in a single-center cohort of 3,646 adult patients undergoing major vascular surgery. We defined AKI using KDIGO (Kidney Disease: Improving Global Outcomes) criteria as change in creatinine ≥ 0.3 mg/dl or ≥50% increase from the reference value. CKD was determined from medical history. Regression models were adjusted for demographic and socio-economic characteristics, comorbid conditions, surgery type, and postoperative complications.
RESULTS: The prevalence of kidney disease among vascular surgery patients is high with 49% of patients developing AKI during hospitalization and 17% presenting with CKD on admission. In risk-adjusted logistic regression analysis, perioperative AKI (OR 2.2, 95% CI 1.5-3.3) was the most significant predictor of ninety-day mortality. The risk-adjusted average cost was significantly higher for patients with any type of kidney disease. The incremental cost of having any type of kidney disease ranged from $9,100 to $19,100, even after adjustment for underlying comorbidities and other postoperative complications.
CONCLUSION: Kidney disease after major vascular surgery is associated with significant increase in ninety-day mortality and cost with the highest risk observed among patients with AKI regardless of previous CKD.
Ann Vasc Surg. 2015 Jul 14. pii: S0890-5096(15)00529-4. doi: 10.1016/j.avsg.2015.04.092. [Epub ahead of print]
Huber M1, Ozrazgat-Baslanti T1, Thottakkara P1, Efron PA2, Feezor R2, Hobson C3, Bihorac A4.
1Department of Anesthesiology, University of Florida, Gainesville, FL.
2Department of Surgery, University of Florida, Gainesville, FL.
3Department of Surgery, Malcom Randall VA Medical Center, Gainesville, FL; Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL.
4Department of Anesthesiology, University of Florida, Gainesville, FL.