Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost

Albert P Nguyen; Rodney A Gabriel; Eugene Golts; Erik B Kistler; Ulrich Schmidt

doi:10.1053/j.jvca.2017.02.004

Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost

J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1361-1369. doi: 10.1053/j.jvca.2017.02.004. Epub 2017 Feb 5.

Authors

Albert P Nguyen¹, Rodney A Gabriel², Eugene Golts³, Erik B Kistler⁴, Ulrich Schmidt⁵

Affiliations

¹ Department of Anesthesiology, University of California San Diego, San Diego, CA. Electronic address: apn019@ucsd.edu.
² Department of Anesthesiology, University of California San Diego, San Diego, CA; Department of Biomedical Informatics, University of California San Diego, San Diego, CA; Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA.
³ Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA.
⁴ Department of Anesthesiology, University of California San Diego, San Diego, CA; Department of Anesthesiology, VA San Diego Health Care System, La Jolla, CA.
⁵ Department of Anesthesiology, University of California San Diego, San Diego, CA.

PMID: 28455097
DOI: 10.1053/j.jvca.2017.02.004

Abstract

Objective: Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated.

Design: Retrospective.

Setting: University hospital.

Participants: Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015.

Measured data: The incidences of AKI and ARF, as defined using the Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria, were measured. Perioperative events were analyzed to identify risk factors for renal compromise. A comparison of ventilator days, intensive care unit (ICU) and hospital lengths of stay (LOS), 1-year readmissions, and emergency department visits was performed among AKI, ARF, and uninjured patients.

Measurements and main results: Ninety-seven patients underwent lung transplantation; 22 patients developed AKI and 35 patients developed ARF. Patients with ARF had significantly longer ICU LOS (12 days v 4 days, p < 0.001); ventilator days (4.5 days v 1 day, p < 0.001); and hospital LOS (22.5 days v 14 days, p < 0.001) compared with uninjured patients. Patients with AKI also had significantly longer ICU and hospital LOS. Patients with ARF had significantly more emergency department visits and hospital readmissions (2 v 1 readmissions, p = 0.002) compared with uninjured patients. A univariable analysis suggested that prolonged surgical time, intraoperative vasopressor use, and cardiopulmonary bypass use were associated with the highest increased risk for AKI. Intraoperative vasopressor use and cardiopulmonary bypass mean arterial pressure <60 mmHg were identified as independent risk factors by multivariable analysis for AKI.

Conclusion: The severity of AKI was associated with an increase in the use of healthcare resources after surgery and discharge. Certain risk factors appeared modifiable and may reduce the incidence of AKI and ARF.

Keywords: RIFLE criteria; cardiopulmonary bypass; cost analysis; lung transplantation; readmission rate.

MeSH terms

Acute Kidney Injury / diagnosis
Acute Kidney Injury / economics*
Acute Kidney Injury / etiology
Adult
Female
Health Care Costs* / trends
Health Resources / economics*
Health Resources / statistics & numerical data*
Humans
Lung Transplantation / adverse effects
Lung Transplantation / economics*
Lung Transplantation / trends
Male
Middle Aged
Postoperative Complications / diagnosis
Postoperative Complications / economics*
Postoperative Complications / etiology
Retrospective Studies
Severity of Illness Index