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

Jeremiah R. Brown, Chirag Parikh, Cathy S. Ross, Robert S. Kramer, Patrick C. Magnus, Kristine Chaisson, Richard A. Boss, Robert E. Helm, Susan R. Horton, Patricia Hofmaster, Helen Desaulniers, Pamela Blajda, Benjamin M. Westbrook, Dennis Duquette, Kelly Leblond, Reed D. Quinn, Cheryl Jones, Anthony W. Discipio, David J. Malenka

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)111-117
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number1
DOIs
StatePublished - Jan 1 2014

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Acute Kidney Injury
Thoracic Surgery
Patient Readmission
New England
Coronary Artery Bypass
Registries
Dialysis
Creatinine
Cardiovascular Diseases
Logistic Models
Odds Ratio
Confidence Intervals

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 journalArticle

Brown, JR, Parikh, C, Ross, CS, Kramer, RS, Magnus, PC, Chaisson, K, Boss, RA, Helm, RE, Horton, SR, Hofmaster, P, Desaulniers, H, Blajda, P, Westbrook, BM, Duquette, D, Leblond, K, Quinn, RD, Jones, C, Discipio, AW & Malenka, DJ 2014, 'Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery', Annals of Thoracic Surgery, vol. 97, no. 1, pp. 111-117. https://doi.org/10.1016/j.athoracsur.2013.07.090
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. / Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 1. pp. 111-117.
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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.",
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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.

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