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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 111-117 |
| Number of pages | 7 |
| Journal | Annals of Thoracic Surgery |
| Volume | 97 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2014 |
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ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery. / Brown, Jeremiah R.; Parikh, Chirag; Ross, Cathy S.; Kramer, Robert S.; Magnus, Patrick C.; Chaisson, Kristine; Boss, Richard A.; Helm, Robert E.; Horton, Susan R.; Hofmaster, Patricia; Desaulniers, Helen; Blajda, Pamela; Westbrook, Benjamin M.; Duquette, Dennis; Leblond, Kelly; Quinn, Reed D.; Jones, Cheryl; Discipio, Anthony W.; Malenka, David J.
In: Annals of Thoracic Surgery, Vol. 97, No. 1, 01.01.2014, p. 111-117.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery
AU - Brown, Jeremiah R.
AU - Parikh, Chirag
AU - Ross, Cathy S.
AU - Kramer, Robert S.
AU - Magnus, Patrick C.
AU - Chaisson, Kristine
AU - Boss, Richard A.
AU - Helm, Robert E.
AU - Horton, Susan R.
AU - Hofmaster, Patricia
AU - Desaulniers, Helen
AU - Blajda, Pamela
AU - Westbrook, Benjamin M.
AU - Duquette, Dennis
AU - Leblond, Kelly
AU - Quinn, Reed D.
AU - Jones, Cheryl
AU - Discipio, Anthony W.
AU - Malenka, David J.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84891606326&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84891606326&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2013.07.090
DO - 10.1016/j.athoracsur.2013.07.090
M3 - Article
AN - SCOPUS:84891606326
VL - 97
SP - 111
EP - 117
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -