Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755 |
Resumo: | Introduction: Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test.Material and Methods: In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient’s death. The economic analysis was performed from the hospital costs’ perspective. Results: Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 – 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 – 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 – 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 – 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 – 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145.Conclusion: Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings. |
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Kidney Injury after Cardiac Surgery: Prevention-Associated Cost ReductionLesão Renal no Pós-Operatório de Cirurgia Cardíaca: Redução de Custos Associada à PrevençãoAcute Kidney Injury/economicsAcute Kidney Injury/etiologyBiomarkersCardiac Surgical Procedures/adverse effectsHospital CostsRisk FactorsBiomarcadoresCustos HospitalaresFatores de RiscoLesão Renal Aguda/económicaLesão Renal Aguda/etiologiaProcedimentos Cirúrgicos Cardíacos/efeitos adversosIntroduction: Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test.Material and Methods: In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient’s death. The economic analysis was performed from the hospital costs’ perspective. Results: Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 – 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 – 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 – 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 – 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 – 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145.Conclusion: Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.Introdução: A cirurgia cardíaca pode induzir lesão renal aguda e levar à necessidade de terapêutica de substituição renal. A esta cirurgia associam-se também maiores custos hospitalares, morbilidade e mortalidade. Os objetivos deste estudo foram investigar os preditores de lesão renal aguda associada a cirurgia cardíaca na nossa população e determinar o impacto da lesão renal aguda na cirurgia cardíaca eletiva. Avaliou-se também o potencial custo-efetividade da sua prevenção através da aplicação do Kidney Disease: Improving Global Outcomes bundle of care a grupos de doentes de alto risco identificados pelo [TIMP-2]x[IGFBP7] como teste de rastreio.Material e Métodos: Foi realizado um estudo retrospetivo num centro hospitalar universitário, onde foi analisada uma amostra consecutiva de adultos que foram submetidos a cirurgia cardíaca eletiva entre janeiro e março de 2015. Durante o período do estudo, foram admitidos no total 276 doentes. Os dados de todos os doentes foram analisados até à alta hospitalar ou morte do doente. Foi realizada uma análise económica da perspetiva de custos para o hospital.Resultados: Oitenta e seis doentes (31%) desenvolveram lesão renal aguda no pós-operatório de cirurgia cardíaca. Após ajuste, os valores elevados de creatinina sérica pré-operatória (mg/L, ORadj = 1,09; IC 95%: 1,01 – 1,17), hemoglobina pré-operatória baixa (g/dL, ORadj = 0,79; IC 95%: 0,67 – 0,94), hipertensão arterial sistémica crónica (ORadj = 5,00; IC 95%: 1,67 – 15,02), tempo prolongado de circulação extra-corporal (min, ORadj = 1,01; IC 95%: 1,00 – 1,01) e o uso perioperatório de nitroprussiato de sódio (ORadj = 6,33; IC 95%: 1,80 – 22,28) mantiveram-se significativamente associados a lesão renal aguda no pós-operatório de cirurgia cardíaca. O custo cumulativo foi de €120 695,84. Baseando-nos numa redução de risco absoluta de 16,6%, ao dosear os biomarcadores de lesão renal estrutural em todos os doentes juntamente com medidas preventivas de lesão renal aguda nos doentes de alto risco, esperaríamos um ponto de equilíbrio ao tratar 78 doentes, que se traduziria, na nossa coorte, num benefício total de custos de €7145.Conclusão: A hemoglobina pré-operatória, creatinina sérica, hipertensão sistémica, tempo de bypass cardiopulmonar e o uso perioperatório de nitroprussiato de sódio foram preditores independentes de lesão renal aguda associada a cirurgia cardíaca. O nosso modelo de custo-efetividade sugere que o uso de biomarcadores renais em combinação com estratégias preventivas precoces poderá estar relacionado com uma potencial poupança de custos.Ordem dos Médicos2023-03-08info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755Acta Médica Portuguesa; Vol. 36 No. 9 (2023): September; 567-576Acta Médica Portuguesa; Vol. 36 N.º 9 (2023): Setembro; 567-5761646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755/15066Direitos de Autor (c) 2023 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessMaia, JoãoRodrigues, Ana FilipaDias, Ana LídiaAzevedo, BárbaraLeite-Moreira, AndréLourenço, AndréAlmeida, Cláudia2023-09-03T03:00:33Zoai:ojs.www.actamedicaportuguesa.com:article/18755Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:21:56.657564Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction Lesão Renal no Pós-Operatório de Cirurgia Cardíaca: Redução de Custos Associada à Prevenção |
title |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
spellingShingle |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction Maia, João Acute Kidney Injury/economics Acute Kidney Injury/etiology Biomarkers Cardiac Surgical Procedures/adverse effects Hospital Costs Risk Factors Biomarcadores Custos Hospitalares Fatores de Risco Lesão Renal Aguda/económica Lesão Renal Aguda/etiologia Procedimentos Cirúrgicos Cardíacos/efeitos adversos |
title_short |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
title_full |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
title_fullStr |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
title_full_unstemmed |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
title_sort |
Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction |
author |
Maia, João |
author_facet |
Maia, João Rodrigues, Ana Filipa Dias, Ana Lídia Azevedo, Bárbara Leite-Moreira, André Lourenço, André Almeida, Cláudia |
author_role |
author |
author2 |
Rodrigues, Ana Filipa Dias, Ana Lídia Azevedo, Bárbara Leite-Moreira, André Lourenço, André Almeida, Cláudia |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Maia, João Rodrigues, Ana Filipa Dias, Ana Lídia Azevedo, Bárbara Leite-Moreira, André Lourenço, André Almeida, Cláudia |
dc.subject.por.fl_str_mv |
Acute Kidney Injury/economics Acute Kidney Injury/etiology Biomarkers Cardiac Surgical Procedures/adverse effects Hospital Costs Risk Factors Biomarcadores Custos Hospitalares Fatores de Risco Lesão Renal Aguda/económica Lesão Renal Aguda/etiologia Procedimentos Cirúrgicos Cardíacos/efeitos adversos |
topic |
Acute Kidney Injury/economics Acute Kidney Injury/etiology Biomarkers Cardiac Surgical Procedures/adverse effects Hospital Costs Risk Factors Biomarcadores Custos Hospitalares Fatores de Risco Lesão Renal Aguda/económica Lesão Renal Aguda/etiologia Procedimentos Cirúrgicos Cardíacos/efeitos adversos |
description |
Introduction: Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test.Material and Methods: In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient’s death. The economic analysis was performed from the hospital costs’ perspective. Results: Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 – 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 – 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 – 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 – 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 – 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145.Conclusion: Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-03-08 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/18755/15066 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2023 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2023 Acta Médica Portuguesa |
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openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 36 No. 9 (2023): September; 567-576 Acta Médica Portuguesa; Vol. 36 N.º 9 (2023): Setembro; 567-576 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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