Costs and outcomes of acute kidney injury (AKI) following cardiac surgery.
BACKGROUND
Acute kidney injury (AKI) is a recognized complication of cardiac surgery; however, the variability in costs and outcomes reported are due, in part, to different criteria for diagnosing and classifying AKI. We determined costs, resource use and mortality rate of patients. We used the serum creatinine component of the RIFLE system to classify AKI.


METHODS
A retrospective cohort study was conducted from the electronic data repository at the University of Pittsburgh Medical Center of patients who underwent cardiac surgery and had an elevation (>or=0.5 mg/dl) of serum creatinine postoperatively. Data were compared to age- and APACHE III-matched controls. Cost, mortality and resource use of AKI patients were determined postoperatively for each of the three RIFLE classes on the basis of changes in serum creatinine.


RESULTS
Of the 3741 admissions, 258 (6.9%) had AKI and were classified as RIFLE-R 138 (3.7%), RIFLE-I 70 (1.9%) and RIFLE-F 50 (1.3%). Total and departmental level costs, length of stay (LOS) and requirement for renal replacement therapy (RRT) were higher in AKI patients compared to controls. Statistically significant differences in all costs, mortality rate and requirement for RRT were seen in the patients stratified into RIFLE-R, RIFLE-I and RIFLE-F. Even patients with the smallest change in serum creatinine, namely RIFLE-R, had a 2.2-fold greater mortality, a 1.6-fold increase in ICU LOS and 1.6-fold increase in total postoperative costs compared to controls.


CONCLUSIONS
Costs, LOS and mortality are higher in postoperative cardiac surgery patients who develop AKI using RIFLE criteria, and these values increase as AKI severity worsens.
Dasta
Joseph F
JF
College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA.
Kane-Gill
Sandra L
SL
Durtschi
Amy J
AJ
Pathak
Dev S
DS
Kellum
John A
JA
D058186:Acute Kidney Injury / Q000191:economics* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D038801:International Classification of Diseases; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012016:Reference Values; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D003404:Creatinine