Acute kidney injury after major surgery: A retrospective analysis of veterans health administration data

Morgan E. Grams, Yingying Sang, Josef Coresh, Shoshana Ballew, Kunihiro Matsushita, Miklos Z. Molnar, Zoltan Szabo, Kamyar Kalantar-Zadeh, Csaba Kovesdy

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Abstract

Background Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI. Study Design Observational cohort study. Setting & Participants 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes. Factors Demographics, health characteristics, and type of surgery. Outcomes Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality. Results Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90 mL/min/1.73 m2, lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes. Limitations Urine output was not available to classify AKI; cohort included mostly men. Conclusions AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.

Original languageEnglish (US)
Pages (from-to)872-880
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume67
Issue number6
DOIs
StatePublished - Jun 1 2016

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Veterans Health
United States Department of Veterans Affairs
Acute Kidney Injury
Thoracic Surgery
Pharynx
Glomerular Filtration Rate
Nose
Chronic Kidney Failure
Observational Studies
Orthopedics
Ear
Blood Vessels
Dialysis
Length of Stay
Thorax
Patient Readmission
Mortality
Veterans

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Acute kidney injury after major surgery : A retrospective analysis of veterans health administration data. / Grams, Morgan E.; Sang, Yingying; Coresh, Josef; Ballew, Shoshana; Matsushita, Kunihiro; Molnar, Miklos Z.; Szabo, Zoltan; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: American Journal of Kidney Diseases, Vol. 67, No. 6, 01.06.2016, p. 872-880.

Research output: Contribution to journalArticle

Grams, ME, Sang, Y, Coresh, J, Ballew, S, Matsushita, K, Molnar, MZ, Szabo, Z, Kalantar-Zadeh, K & Kovesdy, C 2016, 'Acute kidney injury after major surgery: A retrospective analysis of veterans health administration data', American Journal of Kidney Diseases, vol. 67, no. 6, pp. 872-880. https://doi.org/10.1053/j.ajkd.2015.07.022
Grams, Morgan E. ; Sang, Yingying ; Coresh, Josef ; Ballew, Shoshana ; Matsushita, Kunihiro ; Molnar, Miklos Z. ; Szabo, Zoltan ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Acute kidney injury after major surgery : A retrospective analysis of veterans health administration data. In: American Journal of Kidney Diseases. 2016 ; Vol. 67, No. 6. pp. 872-880.
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abstract = "Background Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI. Study Design Observational cohort study. Setting & Participants 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes. Factors Demographics, health characteristics, and type of surgery. Outcomes Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality. Results Postoperative AKI occurred in 11.8{\%} of the 161,185 major surgery hospitalizations (stage 1, 76{\%}; stage 2, 15{\%}, stage 3 [without dialysis], 7{\%}; and AKI requiring dialysis, 2{\%}). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95{\%} CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95{\%} CI, 0.87-0.98), orthopedic (RR, 0.70; 95{\%} CI, 0.67-0.73), vascular (RR, 0.68; 95{\%} CI, 0.64-0.71), urologic (RR, 0.65; 95{\%} CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95{\%} CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90 mL/min/1.73 m2, lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21{\%} vs 13{\%}), 1-year end-stage renal disease (0.94{\%} vs 0.05{\%}), and mortality (19{\%} vs 8{\%}), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes. Limitations Urine output was not available to classify AKI; cohort included mostly men. Conclusions AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.",
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T1 - Acute kidney injury after major surgery

T2 - A retrospective analysis of veterans health administration data

AU - Grams, Morgan E.

AU - Sang, Yingying

AU - Coresh, Josef

AU - Ballew, Shoshana

AU - Matsushita, Kunihiro

AU - Molnar, Miklos Z.

AU - Szabo, Zoltan

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba

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N2 - Background Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI. Study Design Observational cohort study. Setting & Participants 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes. Factors Demographics, health characteristics, and type of surgery. Outcomes Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality. Results Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90 mL/min/1.73 m2, lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes. Limitations Urine output was not available to classify AKI; cohort included mostly men. Conclusions AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.

AB - Background Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI. Study Design Observational cohort study. Setting & Participants 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes. Factors Demographics, health characteristics, and type of surgery. Outcomes Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality. Results Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90 mL/min/1.73 m2, lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes. Limitations Urine output was not available to classify AKI; cohort included mostly men. Conclusions AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.

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