title: Mortality and Cost of Acute and Chronic Kidney Disease after Vascular Surgery.
abstract: BACKGROUND
  Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common yet underappreciated risk factors for adverse perioperative outcomes. We hypothesize that AKI and CKD are associated with similar increases in 90-day mortality and cost in patients undergoing major vascular surgery.
  
  
  METHODS
  We used multivariable regression analyses to evaluate the associations between AKI and CKD and incremental 90-day mortality and hospital cost in a single-center cohort of 3646 adult patients undergoing major vascular surgery. We defined AKI using Kidney Disease: Improving Global Outcomes criteria as change in creatinine ≥ 0.3 mg/dL or ≥ 50% increase from the reference value. CKD was determined from medical history. Regression models were adjusted for demographic and socioeconomic characteristics, comorbid conditions, surgery type, and postoperative complications.
  
  
  RESULTS
  The prevalence of kidney disease among vascular surgery patients is high with 49% of patients developing AKI during hospitalization and 17% presenting with CKD on admission. In risk-adjusted logistic regression analysis, perioperative AKI (odds ratio 2.2, 95% confidence interval 1.5-3.3) was the most significant predictor of 90-day mortality. The risk-adjusted average cost was significantly higher for patients with any type of kidney disease. The incremental cost of having any type of kidney disease ranged from $9100 to $19,100, even after adjustment for underlying comorbidities and other postoperative complications.
  
  
  CONCLUSIONS
  Kidney disease after major vascular surgery is associated with significant increases in 90-day mortality and cost with the highest risk observed among patients with AKI regardless of previous CKD.
authors.affiliation: Department of Anesthesiology, University of Florida, Gainesville, FL.
authors.forename: Matthew
authors.initials: M
authors.lastname: Huber
authors.affiliation: Department of Anesthesiology, University of Florida, Gainesville, FL.
authors.forename: Tezcan
authors.initials: T
authors.lastname: Ozrazgat-Baslanti
authors.affiliation: Department of Anesthesiology, University of Florida, Gainesville, FL.
authors.forename: Paul
authors.initials: P
authors.lastname: Thottakkara
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Efron
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL.
authors.forename: Robert
authors.initials: R
authors.lastname: Feezor
authors.affiliation: Department of Surgery, Malcom Randall VA Medical Center, Gainesville, FL; Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL.
authors.forename: Charles
authors.initials: C
authors.lastname: Hobson
authors.affiliation: Department of Anesthesiology, University of Florida, Gainesville, FL. Electronic address: abihorac@anest.ufl.edu.
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality