Cost and Mortality Associated With Postoperative Acute Kidney Injury

Abstract

OBJECTIVE To determine the incremental hospital cost and mortality associated with the development of postoperative acute kidney injury (AKI) and with other associated postoperative complications. SUMMARY BACKGROUND DATA Each year 1.5 million patients develop a major complication after surgery. Postoperative AKI is one of the most common postoperative complications and is associated with an increase in hospital mortality and decreased survival for up to 15 years after surgery. METHODS In a single-center cohort of 50,314 adult surgical patients undergoing major inpatient surgery we applied risk-adjusted regression models for cost and mortality using postoperative AKI and other complications as the main independent predictors. We defined AKI using consensus RIFLE criteria. RESULTS The prevalence of AKI was 39% among 50,314 patients with available serum creatinine. Patients with AKI were more likely to have postoperative complications and had longer lengths of stay in the intensive care unit and the hospital. The risk-adjusted average cost of care for patients undergoing surgery was $42,600 for patients with any AKI compared to $26,700 for patients without AKI. The risk-adjusted 90-day mortality was 6.5% for patients with any AKI compared to 4.4% for patients without AKI. Serious postoperative complications resulted in increased cost of care and mortality for all patients, but the increase was much larger for those patients with any degree of AKI. CONCLUSIONS Hospital costs and mortality are strongly associated with postoperative AKI, are correlated with the severity of AKI, and are much higher for patients with other postoperative complications in addition to AKI.

Cost of Acute Kidney Injury in Hospitalized Patients

“…13 Most studies that have explored the costs related to hospitalizations complicated by AKI have been single-center or local studies in specialized patient populations. 4,5,[14][15][16][17][18] Very few studies have used data after the year 2000, when the incidence of AKI began to increase, likely related to a combination of patient age, comorbidity burden, sepsis, heart failure, and nephrotoxic medications. 10,11 Moreover, it is unclear which patient and hospital characteristics contribute most to the cost of an AKI hospitalization, and how the costs of AKI compare to those for other acute medical conditions.…”

“…© Society of Hospital Medicine Acute kidney injury (AKI) is a common complication that affects as many as 20% of hospitalized patients, depending on the definition employed. [1][2][3] AKI is associated with significant morbidity and mortality; hospitalized patients with AKI require more investigations and medications, 4 develop more postoperative complications, 5 and spend more time in the intensive care unit than do patients without AKI. 6 Inhospital mortality for patients with AKI has recently been estimated between 20-25%, 3,7 and critically ill patients with AKI requiring dialysis experience mortality rates in excess of 50%.…”

Management of post-operative acute kidney injury

“…Finally, there is evidence surrounding the economic implications of post-operative AKI with significantly higher hospital cost in patients who develop AKI (18).…”

Mortality and Cost of Acute and Chronic Kidney Disease After Vascular Surgery

“…1,4,5 Acute kidney injury (AKI) is a common postoperative complication, and our group has shown that small changes in serum creatinine are associated with increased hospital and intensive care unit lengths of stay as well as hospital and ninety-day mortality rates after major surgery. [7][8][9][10] With the emergence of consensus criteria to standardize the definition of this postoperative complication, especially with mild and moderate degrees of AKI, recent studies within the vascular literature have demonstrated that AKI prevalence ranges from 13%-76% and is associated with adverse perioperative outcomes. [11][12][13][14] Many of these studies have focused on the prevalence of AKI after a specific procedure using small patient cohorts.…”