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Multicenter Study
. 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

Jeremiah R Brown  1 , Chirag R Parikh  2 , Cathy S Ross  3 , Robert S Kramer  4 , Patrick C Magnus  3 , Kristine Chaisson  5 , Richard A Boss Jr  5 , Robert E Helm  6 , Susan R Horton  7 , Patricia Hofmaster  8 , Helen Desaulniers  9 , Pamela Blajda  9 , Benjamin M Westbrook  9 , Dennis Duquette  6 , Kelly LeBlond  7 , Reed D Quinn  4 , Cheryl Jones  5 , Anthony W DiScipio  10 , David J Malenka  3 ; Northern New England Cardiovascular Disease Study Group
Affiliations
Multicenter Study

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

Jeremiah R Brown et al. Ann Thorac Surg. 2014 Jan.

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.

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Conflict of interest statement

There are no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
30-day readmission rates of patients without AKI, developing AKI stage 1, AKI stage 2 and AKI stage.
Figure 2
Figure 2
Odds ratios.
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    Jessen ME. Jessen ME. Ann Thorac Surg. 2014 Jan;97(1):117. doi: 10.1016/j.athoracsur.2013.08.052. Ann Thorac Surg. 2014. PMID: 24384168 No abstract available.

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