Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak, Nicholas; Bïhorac, Azra; Hobson, Charles

doi:10.1097/aco.0000000000000422

Cited by 37 publications

(25 citation statements)

References 41 publications

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“…The permanency of patient in the hospital was minimally estimated in 15 days, in contrast, the maximum was 82 days. Acute kidney injury is a problem to health resulting from different causes and is related to high mortality rates and long periods of hospital admission (8) , finding identified in the present study.…”

Section: Discussionsupporting

confidence: 65%

“…The acquisition of better comprehension about survivors´ clinical history with hospital renal injury, at greater risk for progressive chronic kidney disease and death is vital importance for public health. Scientific evidences have showed that milder forms of renal injury, that not require dialysis are associated to short and long-term mortality (7)(8) .…”

Section: Introductionmentioning

confidence: 99%

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Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury

2018

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Objective: to identify the influence of variations on serum creatinine on outcomes of patients with acute kidney failure. Methods: observational and prospective study. Eighty-five patients which evolved with renal impairment composed the sample. The data was extracted from medical records and reported in a questionnaire created previously. It was considered values p≤0.05 as significant. Results: most of patients were male gender (51.8%) and elder (66±14 years). The reduction of kidney function occurred in different graduation, considering that 35.3% evolved with risk to kidney injury (stage 1) and lower percentage (14.1%) was more severely affected (stage 2 and 3), respectively. During follow-up, the clearance creatinine progressively increased showing recovery of kidney function. Patients with renal injury or failure (stage 2 or 3) evolved more frequently to death (p=0,027). Conclusion: variations on serum creatinine may exacerbate the patient outcomes over hospitalization period. Descriptors: Acute Kidney Injury; Creatinine; Mortality. Objetivo: identificar a influência de variações na creatinina sérica sobre o desfecho dos pacientes com lesão renal aguda. Métodos: estudo observacional prospectivo. A amostra foi composta de 85 pacientes que evoluíram com comprometimento renal. Os dados foram extraídos do prontuário e registrados em questionário construído previamente. Valores com p≤0,05 foram considerados significativos. Resultados: a maioria dos pacientes era do sexo masculino (51,8%) e idosos (66±14 anos). A redução da função renal ocorreu em graduações diferentes, haja vista que 35,3% evoluiu com risco para lesão renal (estágio 1) e um menor percentual (14,1%) foi acometido mais gravemente (estágios 2 e 3), respectivamente. O clearance de creatinina aumentou progressivamente revelando recuperação da função renal ao longo do acompanhamento. Pacientes com lesão ou falência renal (estágios 2 ou 3) evoluíram mais frequentemente ao óbito (p=0,027). Conclusão: variações na creatinina sérica podem agravar o desfecho do paciente ao longo do período de internação. Descritores: Lesão Renal Aguda; Creatinina; Mortalidade.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury

2018

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“…Our study reports increase resource utilization in terms of increase LOS and cost of hospitalization in patients with ESRD undergoing TMVr. The results have been replicated in studies looking at renal disease cost in patients with coronary artery and valvular disease 31,32 …”

Section: Discussionmentioning

confidence: 86%

In‐hospital outcomes of transcatheter mitral valve repair in patients with and without end stage renal disease: A national propensity match study

Khan

Zahid

Khan

et al. 2021

Cathet Cardio Intervent

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Objectives To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end‐stage renal disease (ESRD). Background Renal disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr. Methods We analyzed NIS data from January 2010 to December 2017 using the ICD‐9‐CM codes ICD‐10‐CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒2 test for categorical variables and independent samples t‐test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values. Results A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in‐hospital mortality was lower in non‐ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non‐home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503). Conclusion ESRD is associated with higher mortality, complications, and resource utilization compared to non‐ESRD patients. It is important to include this data in shared decision‐making process and patient selection.

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“…It is associated with an increase in mortality, short- and long-term morbidity, chronic kidney disease, and cardiovascular disease [3–7]. An episode of postoperative AKI imposes an average hospital cost increase of $9000, even after adjusting for all other complications [8, 9]. The implementation of existing clinical guidelines for prevention and treatment of AKI is often hindered by the inability to accurately and timely assess the risk for AKI while accounting for the dynamic nature of the pathophysiological events during surgery.…”

Section: Introductionmentioning

confidence: 99%

Improved predictive models for acute kidney injury with IDEA: Intraoperative Data Embedded Analytics

et al. 2019

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Background Acute kidney injury (AKI) is a common complication after surgery that is associated with increased morbidity and mortality. The majority of existing perioperative AKI risk prediction models are limited in their generalizability and do not fully utilize intraoperative physiological time-series data. Thus, there is a need for intelligent, accurate, and robust systems to leverage new information as it becomes available to predict the risk of developing postoperative AKI. Methods A retrospective single-center cohort of 2,911 adults who underwent surgery at the University of Florida Health between 2000 and 2010 was utilized for this study. Machine learning and statistical analysis techniques were used to develop perioperative models to predict the risk of developing AKI during the first three days after surgery, first seven days after surgery, and overall (after surgery during the index hospitalization). The improvement in risk prediction was examined by incorporating intraoperative physiological time-series variables. Our proposed model enriched a preoperative model that produced a probabilistic AKI risk score by integrating intraoperative statistical features through a machine learning stacking approach inside a random forest classifier. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and Net Reclassification Improvement (NRI). Results The predictive performance of the proposed model is better than the preoperative data only model. The proposed model had an AUC of 0.86 (accuracy of 0.78) for the seven-day AKI outcome, while the preoperative model had an AUC of 0.84 (accuracy of 0.76). Furthermore, by integrating intraoperative features, the algorithm was able to reclassify 40% of the false negative patients from the preoperative model. The NRI for each outcome was AKI at three days (8%), seven days (7%), and overall (4%). Conclusions Postoperative AKI prediction was improved with high sensitivity and specificity through a machine learning approach that dynamically incorporated intraoperative data.

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Mortality and cost of acute and chronic kidney disease after cardiac surgery

Cited by 37 publications

References 41 publications

Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury

Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury

In‐hospital outcomes of transcatheter mitral valve repair in patients with and without end stage renal disease: A national propensity match study

Improved predictive models for acute kidney injury with IDEA: Intraoperative Data Embedded Analytics

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