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Ann Thorac Surg. 2014 Jan;97(1):111-7. doi: 10.1016/j.athoracsur.2013.07.090. Epub 2013 Oct 8.

Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery.

Author information

  • 1Departments of Medicine Section of Cardiology and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: jbrown@dartmouth.edu.
  • 2Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
  • 3Departments of Medicine Section of Cardiology and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
  • 4Department of Surgery, Maine Medical Center, Portland, Maine.
  • 5Department of Surgery, Concord Hospital, Concord, New Hampshire.
  • 6Department of Surgery, Portsmouth Regional Hospital, Portsmouth, New Hampshire.
  • 7Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine.
  • 8Department of Surgery, Eastern Maine Medical Center, Bangor, Maine.
  • 9Department of Surgery, Catholic Medical Center, Manchester, New Hampshire.
  • 10Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

BACKGROUND:

Of patients undergoing cardiac surgery in the United States, 15% to 20% are re-hospitalized within 30 days. Current models to predict readmission have not evaluated the association between severity of postoperative acute kidney injury (AKI) and 30-day readmissions.

METHODS:

We collected data from 2,209 consecutive patients who underwent either coronary artery bypass or valve surgery at 7 member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry between July 2008 and December 2010. Administrative data at each hospital were searched to identify all patients readmitted to the index hospital within 30 days of discharge. We defined AKI stages by the AKI Network definition of 0.3 or 50% increase (stage 1), twofold increase (stage 2), and a threefold or 0.5 increase if the baseline serum creatinine was at least 4.0 (mg/dL) or new dialysis (stage 3). We evaluate the association between stages of AKI and 30-day readmission using multivariate logistic regression.

RESULTS:

There were 260 patients readmitted within 30 days (12.1%). The median time to readmission was 9 (interquartile range, 4 to 16) days. Patients not developing AKI after cardiac surgery had a 30-day readmission rate of 9.3% compared with patients developing AKI stage 1 (16.1%), AKI stage 2 (21.8%), and AKI stage 3 (28.6%, p < 0.001). Adjusted odds ratios for AKI stage 1 (1.81; 1.35, 2.44), stage 2 (2.39; 1.38, 4.14), and stage 3 (3.47; 1.85 to 6.50). Models to predict readmission were significantly improved with the addition of AKI stage (c-statistic 0.65, p = 0.001) and net reclassification rate of 14.6% (95% confidence interval: 5.05% to 24.14%, p = 0.003).

CONCLUSIONS:

In addition to more traditional patient characteristics, the severity of postoperative AKI should be used when assessing a patient's risk for readmission.

KEYWORDS:

4

Comment in

PMID:
24119985
PMCID:
PMC4009924
DOI:
10.1016/j.athoracsur.2013.07.090
[PubMed - indexed for MEDLINE]
Free PMC Article
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