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Review
. 2017 Feb;30(1):113-117.
doi: 10.1097/ACO.0000000000000422.

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

Nicholas Lysak  1 , Azra Bihorac, Charles Hobson
Affiliations
Review

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

Nicholas Lysak et al. Curr Opin Anaesthesiol. 2017 Feb.

Abstract

Purpose of review: Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients.

Recent findings: Both AKI and CKD increase the risk for short-term and long-term mortalities, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes. Even the mildest forms of AKI (RIFLE-R) and CKD (proteinuria without an observed reduction in estimated glomerular filtration rate) demonstrate worse clinical outcomes compared with patients with no AKI or CKD. Outcomes are worse even in patients who achieve full renal recovery before hospital discharge. These complications dramatically increase ICU length of stay, hospital length of stay, resource utilization, and both in-hospital and postdischarge costs, as evidenced by lower rates of discharges to home.

Summary: AKI and CKD remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.

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Figures

Figure 1
Figure 1
A. Risk-adjusted average cost for patients stratified by 90-day survival, occurrence of acute kidney injury and age. Abbreviations: AKI, Acute kidney injury; SE, standard error. B. Risk-adjusted cumulative incremental cost of postoperative complications stratified by occurrence of acute kidney injury. Abbreviations: AKI, Acute kidney injury; No PC, No postoperative complications; PC/MV, Pulmonary complications and/or mechanical ventilation; CV, Cardiovascular complications and/or need for vasopressors; SS, Severe sepsis; NC, Neurological complications and/or delirium; VTE, Venous thromboembolism; WC, Mechanical wound complications and surgical infections; GI, Gastrointestinal complications.
Figure 1
Figure 1
A. Risk-adjusted average cost for patients stratified by 90-day survival, occurrence of acute kidney injury and age. Abbreviations: AKI, Acute kidney injury; SE, standard error. B. Risk-adjusted cumulative incremental cost of postoperative complications stratified by occurrence of acute kidney injury. Abbreviations: AKI, Acute kidney injury; No PC, No postoperative complications; PC/MV, Pulmonary complications and/or mechanical ventilation; CV, Cardiovascular complications and/or need for vasopressors; SS, Severe sepsis; NC, Neurological complications and/or delirium; VTE, Venous thromboembolism; WC, Mechanical wound complications and surgical infections; GI, Gastrointestinal complications.
See this image and copyright information in PMC

References

    1. Hobson CE, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation. 2009;119:2444–53. The single-center retrospective review showed that cardiac surgery patients who developed postoperative AKI had longer ICU and hospital lengths of stay, and increased short and long-term mortality. Patients with complete renal recovery after AKI still had an increased adjusted hazard ratio for death of 1.28 (95% CI 1.11 to 1.48) compared with patients without AKI. - PubMed
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