心脏手术后急性肾损伤发生的中心水平变异

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-06-01 DOI:10.1016/j.cjco.2025.04.003

Troy N. Coaston BS , Joanna Curry BA , Amulya Vadlakonda BS , Saad Mallick MD , Giselle Porter BS , Corynn Branche , Nguyen Le MS , Peyman Benharash MD

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引用次数: 0

摘要

背景：急性肾损伤是心脏手术后常见的并发症。然而，与AKI相关的因素仍然知之甚少。在这项全国性研究中，我们评估了择期心脏手术后AKI发生率的中心水平变化。方法选取2010-2020年全国住院患者样本中基线肾功能正常、接受择期冠状动脉旁路移植术或瓣膜手术的成年患者。采用多层次混合效应模型，根据AKI的估计率对医院进行排名。用类内系数估计医院因素的变异程度。高AKI中心（HACs）被定义为估计AKI发生率最高的十分位数内的中心。还分析了HAC状态、住院死亡率、围手术期并发症、住院时间和住院费用之间的关系。结果在703个中心平均每年的1,324,083例住院患者中，4.9%的患者在HAC（平均每年70个中心）接受手术。与非HACs相比，HACs的年心脏病例量较低（62例[四分位数范围：40-115]vs 145例[四分位数范围：80-265]）；P & lt;0.001)，非白人患者的比例更大(20.0% vs 15.1%；P & lt;0.001)。调整后，HAC与呼吸系统并发症（调整优势比[AOR] 1.72, 95%可信区间[CI] 1.57-1.90）、感染并发症（AOR 1.57, 95% CI 1.40-1.76）和心脏并发症（AOR 1.27, 95% CI 1.18-1.36）增加相关。此外，HAC与住院费用的增量增加相关（β系数+ 4151美元，95% CI 2305- 5997美元）。结论围手术期AKI在医院水平上存在显著差异。HACs与较差的临床结果和较高的资源利用率有关。

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Center-Level Variation in the Development of Acute Kidney Injury Following Cardiac Operation

Background

Acute kidney injury (AKI) is a frequent complication following cardiac surgery. However, factors associated with AKI remain poorly understood. In this national study, we evaluated centre-level variation in the incidence of AKI after elective cardiac surgery.

Methods

Adult patients undergoing elective coronary artery bypass graft or valve operations with normal baseline renal function were identified in the 2010-2020 National Inpatient Sample. Multilevel mixed-effects models were utilized to rank hospitals based on estimated rate of AKI. The intraclass coefficient was used to estimate the level of variation attributable to hospital factors. High AKI centres (HACs) were defined as those within the highest decile of estimated AKI rate. The association between HAC status, in-hospital mortality, perioperative complications, length of stay, and hospitalization costs also were analyzed.

Results

Of 1,324,083 hospitalizations across an annual average of 703 centres, 4.9% of patients received their operation at an HAC (annual average of 70 centres). Compared to non-HACs, HACs had a lower annual cardiac case volume (62 [interquartile range: 40-115] vs 145 [interquartile range: 80-265] cases; P < 0.001) and served a larger proportion of non-White patients (20.0% vs 15.1%; P < 0.001). After adjustment, HAC was associated with increased odds of respiratory complications (adjusted odds ratio [AOR] 1.72, 95% confidence interval [CI] 1.57-1.90), infectious complications (AOR 1.57, 95% CI 1.40-1.76), and cardiac complications (AOR 1.27, 95% CI 1.18-1.36). Additionally, HAC was associated with an incremental increase in hospitalization costs (β coefficient +$4151, 95% CI $2305-$5997).

Conclusions

We demonstrated significant hospital-level variation in perioperative AKI. HACs were associated with inferior clinical outcomes and higher levels of resource utilization.

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