Abstract 13636: Persistent Acute Kidney Injury is Associated With Poor Outcomes and Increased Hospital Cost in Vascular Surgery

• Published in: Circulation (New York, N.Y.) N.Y.), 2022-11, Vol.146 (Suppl_1), p.A13636-A13636
• Main Authors: Hensley, Sara, Filiberto, Amanda, Adiyeke, Esra, Ozrazgat-Baslanti, Tezcan, Upchurch, Gilbert R, Bihorac, Azra, Cooper, Michol
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.146.suppl_1.13636

IntroductionPostoperative acute kidney injury (AKI) is common after vascular surgery and is associated with increased morbidity and mortality. HypothesisIt is hypothesized that patients with persistent postoperative AKI have increased complications, mortality and hospital cost. MethodsA single center retrospective cohort of patients undergoing non-emergent major vascular surgery (lower extremity bypass, endovascular and open aortic surgery), between 2014-2019 was analyzed. Development of postoperative AKI (defined as > 50% or 0.3 mg/dl increase in serum creatinine relative to reference after surgery and before discharge) was evaluated. Patients were divided into 3 groupsno AKI, non-persistent AKI (< 48 hours) and persistent AKI (> 48 hours). Multivariable regression analyses were then used to evaluate the association between AKI status and postoperative complications, 90-day mortality, and hospital cost. ResultsA total of 1,881 patients undergoing 1,980 vascular procedures were included. Thirty five percent of patients developed postoperative AKI. Patients with persistent AKI were more likely to have longer ICU and hospital stays, as well as more mechanical ventilation days. In risk-adjusted logistic regression analysis, persistent AKI was a major predictor of 90-day mortality (OR 4.4, 95% CI 2.5-7.6). Risk-adjusted average cost was higher for patients with any type of AKI. The incremental cost of having any AKI ranged from $5,500-$12,400, even after adjustment for comorbidities and other postoperative complications. The risk-adjusted average cost for patients stratified by type of AKI was higher among patients with persistent AKI compared to those with no or non-persistent AKI (Fig.1). ConclusionsPersistent AKI after vascular surgery is associated with increased complications, mortality and cost. Strategies to prevent and aggressively treat AKI in the perioperative setting are imperative to optimize care for this population.