Filiberto Amanda C, Adiyeke Esra, Ozrazgat-Baslanti Tezcan, Jacobs Christopher R, Fazzone Brian, Bihorac Azra, Upchurch Gilbert R, Cooper Michol
Department of Surgery, University of Florida, Gainesville, FL.
Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL.
Ann Vasc Surg. 2024 Jan;98:342-349. doi: 10.1016/j.avsg.2023.06.023. Epub 2023 Jul 7.
Postoperative acute kidney injury (AKI) is common after major surgery and is associated with increased morbidity, mortality, and cost. Additionally, there are recent studies demonstrating that time to renal recovery may have a substantial impact on clinical outcomes. We hypothesized that patients with delayed renal recovery after major vascular surgery will have increased complications, mortality, and hospital cost.
A single-center retrospective cohort of patients undergoing nonemergent major vascular surgery between 6/1/2014 and 10/1/2020 was analyzed. Development of postoperative AKI (defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria: >50% or > 0.3 mg/dl absolute increase in serum creatinine relative to reference after surgery and before discharge) was evaluated. Patients were divided into 3 groups: no AKI, rapidly reversed AKI (<48 hours), and persistent AKI (≥48 hours). Multivariable generalized linear models were used to evaluate the association between AKI groups and postoperative complications, 90-day mortality, and hospital cost.
A total of 1,881 patients undergoing 1,980 vascular procedures were included. Thirty five percent of patients developed postoperative AKI. Patients with persistent AKI had longer intensive care unit and hospital stays, as well as more mechanical ventilation days. In multivariable logistic regression analysis, persistent AKI was a major predictor of 90-day mortality (odds ratio 4.1, 95% confidence interval 2.4-7.1). Adjusted average cost was higher for patients with any type of AKI. The incremental cost of having any AKI ranged from $3,700 to $9,100, even after adjustment for comorbidities and other postoperative complications. The adjusted average cost for patients stratified by type of AKI was higher among patients with persistent AKI compared to those with no or rapidly reversed AKI.
Persistent AKI after vascular surgery is associated with increased complications, mortality, and cost. Strategies to prevent and aggressively treat AKI, specifically persistent AKI, in the perioperative setting are imperative to optimize care for this population.
术后急性肾损伤（AKI）在大手术后很常见，与发病率、死亡率增加及成本上升相关。此外，最近有研究表明，肾功能恢复时间可能对临床结局有重大影响。我们假设，大血管手术后肾功能恢复延迟的患者并发症、死亡率及住院费用会增加。
对2014年6月1日至2020年10月1日期间接受非急诊大血管手术的患者进行单中心回顾性队列分析。评估术后AKI的发生情况（根据改善全球肾脏病预后组织（KDIGO）标准定义：术后至出院时血清肌酐相对于基线绝对升高>50%或>0.3mg/dl）。患者分为3组：无AKI、快速逆转的AKI（<48小时）和持续性AKI（≥48小时）。使用多变量广义线性模型评估AKI组与术后并发症、90天死亡率及住院费用之间的关联。
共纳入1881例接受1980例血管手术的患者。35%的患者发生术后AKI。持续性AKI患者的重症监护病房和住院时间更长，机械通气天数更多。在多变量逻辑回归分析中，持续性AKI是90天死亡率的主要预测因素（比值比4.1，95%置信区间2.4 - 7.1）。任何类型AKI患者的调整后平均费用更高。即使在调整合并症和其他术后并发症后，发生任何AKI的增量成本在3700美元至9100美元之间。与无AKI或快速逆转AKI的患者相比，持续性AKI患者按AKI类型分层的调整后平均费用更高。
血管手术后持续性AKI与并发症、死亡率及成本增加相关。在围手术期采取预防和积极治疗AKI（特别是持续性AKI）的策略对于优化该人群的治疗至关重要。
