The Society of Thoracic Surgeons definition of acute renal failure requires a 3-fold rise in creatinine, creatinine > 4 mg/dL (with at least 0.5mg/dL rise from preoperative value), or new ...hemodialysis requirement. This definition does not capture the incidence, clinical impact, and economic burden of lesser degrees of acute renal dysfunction. A retrospective cohort study using discharge data from 650 hospitals was extracted from the Premier administrative database (2010–2014) for index cardiac cases (isolated coronary artery bypass grafting, isolated valve, and coronary artery bypass grafting-valve). We documented acute renal dysfunction through International Classification of Diseases (ICD) 9-CM codes and hospital charges, excluding those patients with pre-existing renal dysfunction. The incidence, length of stay , and total hospital costs associated with renal dysfunction for each of the index procedures were captured. The results reported are unadjusted for demographic and clinical factors. A total of 200,471 procedures were available for analysis in the database. The mean age was 66 years, 68.2% were male and 74% were white. Based on ICD 9-CM codes and hospital charges for these cases, 27,216 (13.6%) patients had some level of renal dysfunction. In addition to increase in length of stay, patients who developed renal dysfunction had an associated 57–85% increase in total cost of hospitalization. The incidence of renal dysfunction in this study is higher than reported previously. The Society of Thoracic Surgeons definition of renal failure captures only severe disease and may miss lesser degrees of dysfunction, which nonetheless have an impact on patient outcome and costs.
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Commentary: When you wish upon a valve Levy, Gal; DeAnda, Abe
The Journal of thoracic and cardiovascular surgery,
20/May , Volume:
163, Issue:
5
Journal Article
Abstract
Background
Most patients in the surgical intensive care unit (SICU) have anemia and undergo extensive diagnostic laboratory testing (DLT). Consequently, patients undergo RBC transfusion, and ...many are discharged with anemia, both of which are associated with poorer outcomes.
Objective
To characterize DLT blood loss in the SICU.
Materials and Methods
We performed a 1-year retrospective study of 291 patients admitted to a SICU. The number of draws, average volume, and estimated discard volume were recorded, along with clinical and laboratory findings.
Results
Patients who underwent greater amounts of DLT had lower hemoglobin levels at discharge (P ≤ .001). Admissions requiring central venous catheter (CVC) access (49.8%) demonstrated significantly higher DLT draws and rates of transfusion.
Conclusion
Findings from this study suggest that DLT blood loss contributes to anemia in the SICU, and that the presence and duration of CVC leads to increased testing, anemia, and RBC transfusion.
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