Treatment Costs of Acute Kidney Injury in Patients Undergoing Cardiac Surgery in the UK: A Retrospective Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 4,600
- 试验地点
- 1
- 主要终点
- Overall cost of treatment in £ for the each KDIGO stage of CSA-AKI
研究概览
简要总结
Single-centre retrospective analysis of prospectively collected data with propensity matched scoring groups (AKI v/s non-AKI). Data collection from databases (or their equivalent): PATS Dendrite, Electronic Medical Records, TD-web (results Portal), MedTrack (ICU database), iSite (Radiology), SPY (Long-term status)
详细描述
BACKGROUND Cardiac surgery associated acute kidney injury (CSA-AKI) is reported in 25-40% of patients. This variability is due to a spectrum of definitions used to classify AKI. AKI definition and staging are based on the Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria and the Acute Kidney Injury Network (AKIN) criteria, which have been further refined in the Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group guidelines. It is now customary to use the KDIGO definition or its modified version - the AKIN consensus criteria.
The development of AKI in the post-op cardiac surgery setting is associated with significant morbidity, mortality, prolonged intensive care (ICU) & in-hospital stays, increased treatment costs and poorer long-term survival and quality of life. Despite the ability to identify patients at high risk preoperatively, no effective strategy has yet been established to prevent CSA-AKI.
RATIONALE FOR CURRENT STUDY Acute kidney injury (AKI) is associated with substantial increases in healthcare costs among patients undergoing cardiac surgery. One study estimated that AKI increases costs by $19,212 (£14,437) per patient (non-UK data). In a more recent US study published in 2018, the additional cost attributable to postoperative AKI was estimated at $38,358 (£28,824). This was accompanied by a nearly 10-fold increase in mortality (13.9% vs 1.3%) and a doubling of the mean in-hospital length of stay (18.2 vs 8.6 days) compared with patients without AKI. Similarly, ICU length of stay is significantly prolonged in patients who develop AKI after coronary artery bypass grafting (CABG), with a mean of 5.5 days versus 2.2 days in those without AKI.
STUDY OBJECTIVES Primary Objective: To compare the costs of treatment for patients who develop different stages of cardiac surgery-associated acute kidney injury (CSA-AKI), with the costs for patients who do not develop CSA-AKI, in a UK cardiac surgery population.
Secondary objectives: To determine the incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) using the modified KDIGO criteria (overall and stratified by stage). To compare ICU and in-hospital length of stay. To evaluate the costs of ICU treatment and overall in-hospital stay. To assess survival rates during the index admission and at the time of study follow-up. To calculate the overall hospital costs for the cardiac surgery episode.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Underwent elective or in-house urgent cardiac surgery at the Royal Wolverhampton NHS Trust between 1st January 2013 and 31st December 2025, excluding those who had surgery during 2020 and 2021 due to the confounding effect of COVID-19 on acute kidney injury incidence.
- •Cardiopulmonary bypass (CPB) was utilised during the cardiac surgical procedure.
- •A complete minimum dataset is available within the study databases, comprising: age, sex, history of diabetes, left ventricular ejection fraction (LVEF), surgical priority, pre-operative haemoglobin and serum creatinine (SCr) levels, type of cardiac surgery performed, CPB duration, EuroSCORE or logistic EuroSCORE, renal replacement therapy (RRT) use, and post-operative day 1 and/or day 2 and/or day 3 SCr values.
排除标准
- •The procedure was performed as an emergency surgery.
- •Required data fields are incomplete or unavailable.
- •Surgery was performed off-pump, without the use of cardiopulmonary bypass.
- •The patient was dialysis-dependent prior to surgery.
- •The patient had a pre-operative estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73 m².
- •The cardiac procedure required deep hypothermic circulatory arrest (DHCA).
- •The patient has exercised their right to opt out of research data use.
结局指标
主要结局
Overall cost of treatment in £ for the each KDIGO stage of CSA-AKI
时间窗: From date each patient had surgery to the date each patient discharged from hospital, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction
Based on the KDIGO clinical practice guidelines, AKI is defined in relation to the change in serum creatinine (SCr), use of RRT (Renal Replacement Therapy) and urine output. For this study, CSA-AKI is defined (modified KDIGO) as when any one of the following three criteria are met: 1. An increase in serum creatinine (SCr) by ≥0.3 mg/dl (≥26.5 micromol/l) within 72 hours of surgery compared to the baseline value; or 2. An increase in SCr by ≥1.5 times from SCr value at baseline within 72 hours of surgery; or 3. Use of RRT within 7 days of surgery.
次要结局
- Number of patients with CSA-AKI(From date each patient had surgery to date each patient discharged from hospital, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), , assessed at point of data extraction)
- Days patient spent in ICU(From date each patient had surgery to date each patient discharged from ICU, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction)
- Average cost of ICU stay in £ for each KDIGO CSA-AKI stage(From date each patient had surgery to date each patient discharged from ICU, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction)
- Length of time each patient spent in hospital in days(From date each patient had surgery to date each patient discharged from hospital, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction)
- Number of patients alive upon discharge from hospital(From date each patient had surgery to date each patient discharged from hospital, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction)
- Number of patients alive at the point of study data collection(From date each patient had surgery to date of data collection, for all eligible patients who underwent surgery between 1st January 2013 and 31st December 2025 (varies from patient to patient), assessed at point of data extraction)