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A594
October 15, 2006 2:00 PM - 4:00 PM Room Hall E, Area G |
| National Trends in Acute Renal Failure Associated with CABG Surgery: Have We Made a Difference? |
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Patricia L. McGugan-Clark, R.N., Steven Talbert, Ph.D., Andrew Shaw, M.D., F.R.C.A., Laura E. Archer, Ph.D., Madhav Swaminathan, M.D. Anesthesiology, Duke University Medical Center, Durham, North Carolina |
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Introduction
Acute renal failure (ARF) is a common major complication of coronary artery bypass (CABG) surgery that is associated with increased morbidity and mortality. Although renal protective strategies have been developed to prevent ARF, patients who present for CABG surgery appear to be at greater renal risk than in previous years. As a result, the overall impact of these strategies on the trend of ARF is still unclear. We therefore hypothesized that the incidence of ARF associated with CABG surgery has changed within the last decade. Methods After IRB approval, the Nationwide Inpatient Sample (NIS) database from the Healthcare Cost Utilization Project was used to identify the number of CABG surgeries associated with ARF from 1998 to 2003. The core NIS datafiles representing a 20% sample of all hospitals in the United States (about 1000 hospitals nationwide) was used for data extraction and analysis. Discharges with the Clinical Classification Software (CCS) procedure code, 44 for CABG surgery, and 157 for ARF were identified as the study population from the core inpatient files for each year. Known renal risk factors were identified as covariates for analysis according to appropriate DRG diagnosis codes. The simple incidence of ARF was calculated for each year. The incidence of specific risk factors was also calculated for each year. The incidence of ARF was then analyzed after adjustment for risk factors (age, female gender, diabetes) and each year's incidence was compared with the previous year. All analyses were conducted using SAS analytical software. Results 439,046 discharges were identified from 1998 to 2003 with the CABG procedure code in the core NIS dataset. Of these, 25,090 (5.7%) had a concurrent diagnosis of ARF. Usual risk factors were identified by logistic regression as significantly associated with ARF (age, female gender, diabetes, congestive heart failure). The incidence of ARF increased from 4.2 % in 1998 to 7.3 % in 2003 (relative increase of 73.8%). The risk-adjusted incidence increased each year from 7.6% in 1998 to 10.7% in 2003. This increment was statistically significant from 2000 to 2003.[figure1]Discussion We found an increasing trend in the incidence of ARF associated with CABG surgery in the last decade. The increase was significant even after adjustment for known renal risk factors. ARF is a serious complication of CABG surgery and is accompanied by a high risk of mortality especially when dialysis is required. Despite numerous studies that have suggested the benefits of reno-protective strategies, the cumulative trend of ARF has not declined in the last six years. One reason for the observed increasing trend may be the adoption of a more liberal definition of ARF, i.e. creatinine-based criteria rather than need for dialysis. Postoperative ARF remains a serious complication that does not seem to have been influenced by any reno-protective strategies implemented in the last decade. More research needs to be done in this area to identify susceptible patients and prevent post-cardiac surgery ARF. Anesthesiology 2006; 105: A594 |
Figure 1
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