Cost and Mortality Associated With Postoperative Acute Kidney Injury.
Cost and Mortality Associated With Postoperative Acute Kidney Injury.
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DOI：
10.1097/sla.0000000000000732
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发表时间：
2015-06
影响因子：
9
通讯作者：
Bihorac A
中科院分区：
文献类型：
--
作者：
Hobson C;Ozrazgat-Baslanti T;Kuxhausen A;Thottakkara P;Efron PA;Moore FA;Moldawer LL;Segal MS;Bihorac A
确定与术后急性肾损伤（阿基）和其他相关术后并发症相关的住院费用和死亡率增量。每年有150万患者在手术后出现严重并发症。术后阿基是最常见的术后并发症之一，与住院死亡率增加和术后15年生存率降低相关。在一项由50，314名接受大型住院手术的成人手术患者组成的单中心队列中，我们采用风险调整回归模型，以术后阿基和其他并发症作为主要独立预测因素，评估成本和死亡率。我们使用共识步枪标准定义阿基。在50，314例血清肌酐可用的患者中，阿基的患病率为39%。阿基患者更有可能发生术后并发症，并且在重症监护室和医院的住院时间更长。接受手术的患者的风险调整后平均护理成本为42，600美元，任何阿基患者为26，700美元，而无阿基患者为26，700美元。任何阿基患者的风险调整后90天死亡率为6.5%，而无阿基患者为4.4%。严重的术后并发症导致所有患者的护理成本和死亡率增加，但对于任何程度的阿基患者，增加幅度更大。住院费用和死亡率与术后阿基密切相关，与阿基的严重程度相关，并且对于除阿基之外还有其他术后并发症的患者来说要高得多。
To determine the incremental hospital cost and mortality associated with the development of postoperative acute kidney injury (AKI) and with other associated postoperative complications. Each year 1.5 million patients develop a major complication after surgery. Postoperative AKI is one of the most common postoperative complications and is associated with an increase in hospital mortality and decreased survival for up to 15 years after surgery. In a single-center cohort of 50,314 adult surgical patients undergoing major inpatient surgery we applied risk-adjusted regression models for cost and mortality using postoperative AKI and other complications as the main independent predictors. We defined AKI using consensus RIFLE criteria. The prevalence of AKI was 39% among 50,314 patients with available serum creatinine. Patients with AKI were more likely to have postoperative complications and had longer lengths of stay in the intensive care unit and the hospital. The risk-adjusted average cost of care for patients undergoing surgery was $42,600 for patients with any AKI compared to $26,700 for patients without AKI. The risk-adjusted 90-day mortality was 6.5% for patients with any AKI compared to 4.4% for patients without AKI. Serious postoperative complications resulted in increased cost of care and mortality for all patients, but the increase was much larger for those patients with any degree of AKI. Hospital costs and mortality are strongly associated with postoperative AKI, are correlated with the severity of AKI, and are much higher for patients with other postoperative complications in addition to AKI.