Mortality and costs associated with acute kidney injury following major elective, non-cardiac surgery.
J Clin Anesth
; 82: 110933, 2022 11.
Article
en En
| MEDLINE
| ID: mdl-35933842
ABSTRACT
OBJECTIVE:
This study evaluated postoperative AKI severity and its relation to short- and long-term patient outcomes.DESIGN:
A retrospective, single-center cohort study of patients undergoing surgery from January 2015 to May 2020.SETTING:
An urban, academic medical center. PATIENTS Adult 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.INTERVENTIONS:
None. MEASUREMENTS Postoperative 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. MAINRESULTS:
Of 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).CONCLUSIONS:
All 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
/
Lesión Renal Aguda
Tipo de estudio:
Etiology_studies
/
Health_economic_evaluation
/
Incidence_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Humans
Idioma:
En
Revista:
J Clin Anesth
Asunto de la revista:
ANESTESIOLOGIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos