Preoperative Renal Function Predicts Hospital Costs and Length of Stay in Coronary Artery Bypass Grafting

LaPar, Damien J.; Rich, Jeffrey B.; Isbell, James M.; Brooks, Charles H.; Crosby, Ivan K.; Yarboro, Leora T.; Ghanta, Ravi K.; Kern, John A.; Brown, Michael E.; Quader, Mohammed; Speir, Alan M.; Ailawadi, Gorav

doi:10.1016/j.athoracsur.2015.07.079

Cited by 24 publications

(15 citation statements)

References 24 publications

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“…As worsening kidney function leads to increasing ICU and hospital stays, it may affect benchmarking of institution and surgeons. LaPar et al [29] reported similar finding as ours. They went further and showed that worsening RD also results in incurring higher costs, while optimizing renal function before heart surgery can substantially improve the outcomes and lower the costs.…”

Section: Jg Sciencesupporting

confidence: 89%

Renal Disease is Associated with Poor Outcomes Following Isolated Coronary Artery Bypass Grafting

Alramadan

Karim

Hossain

et al. 2019

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Background: People with renal disease have a markedly higher risk of cardiovascular disease as well as morbidity and mortality after cardiac surgery. Little is known regarding the post-operative adverse outcomes following isolated coronary artery bypass graft (CABG) in the Australian population with renal disease. Objectives: The aim of this study was to examine the effect of different stages of renal disease on patients' risk of post-operative mortality and complications following isolated CABG in an Australian cohort. Methods: Using the ANZSCTS (Australian and New Zealand Society of Cardiac and Thoracic Surgeons) registry, data from 44,968 patients who underwent isolated CABG between 2001 and 2014 were used. The effect of renal disease stages on short-and long-term outcomes were examined using multivariable logistic and Cox's regression methods respectively. Results: Three of 4 Australian patients (74.6%) who underwent isolated CABG had some degree of renal disease: 50.2% mild; 20.9% moderate; 2.1% severe; and 1.6% dialysis-dependent. Adjusted risk of 30-day mortality increased with deteriorating renal disease from mild (1.6-fold) to dialysis-dependent (4.6-fold). Worsening renal disease was also associated with higher risk of post-operative complications. Hazard ratio for long-term survival shows steady increase of mortality risk with worsening renal disease categories from 1.1fold for mild to 3.9-fold for patients on dialysis. Conclusions: Pre-existing renal disease is significantly associated with 30-day and long-term mortality, length of intensive care unit and hospital stay as well as several other post-operative complications.

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Section: Jg Sciencesupporting

confidence: 89%

Renal Disease is Associated with Poor Outcomes Following Isolated Coronary Artery Bypass Grafting

Alramadan

Karim

Hossain

et al. 2019

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“…Furthermore, the incidence of preoperative renal dysfunction in the LD patients too increases healthcare costs and resource utilization. As reported by LaPar et al optimizing renal function, can improve patient costs by 6% ($1250) for every 10 mL/min improvement in creatinine clearance [ 16 ]. Finally, in a fiscal analysis of additive costs for complications in cardiac surgery, renal, respiratory and infectious complications were amongst the highest in additive costs [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of preoperative liver dysfunction on cardiac surgery outcomes

Araujo

Dombrovskiy

Kamran

et al. 2017

J Cardiothorac Surg

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BackgroundTo determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS).MethodsThe Nationwide Inpatient Sample (2002–2010) was queried to identify patients with LD who had elective CABG or VS utilizing ICD-9-CM diagnosis and procedure codes. These patients were matched with the similar patients without LD (controls) by propensity score matching. Chi-square and Wilcoxon rank sum tests were used for analysis.ResultsWe identified 1197 patients with LD (CABG = 755; VS = 442) who were matched to 2394 controls. LD significantly increased hospital mortality after both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 7.49; 95%CI = 3.12–17.96). Overall rates of complications after CABG with LD were greater than in non-complicated cases (OR = 1.73; 95%CI = 1.46–2.05). Among them, there was an increase in bleeding (OR = 1.81;95%CI = 1.44–2.28), respiratory (OR = 2.33;95%CI = 1.86–2.93), renal (OR = 2.79;95%CI = 2.04–3.81), and infectious (OR = 2.93;95%CI = 2.14–4.01) complications. In general, the rates of complications after VS with LD were also greater than in non-complicated cases (OR = 2.77;95%CI = 2.13–3.60), specifically for bleeding (OR = 3.07;95%CI = 2.17–4.34), respiratory (OR = 3.57;95%CI = 2.51–5.07), renal (OR = 4.40;95%CI = 2.80–6.92), and infectious (OR = 4.63;95%CI = 2.85–7.51) complications. The development of LD significantly increased mean hospital length of stay (LOS) and total hospital charges after both CABG (from7.0 ± 4.0 to 9.2 ± 9.1 days and from $100,265 ± 87,107 to $117,756 ± 99,320, respectively; P < 0.0001 for both) and VS (from 7.9 ± 5.0 to 11.4 ± 9.9 days and from $134,306 ± 114,216 to $176,620 ± 147,049, respectively; P < 0.0001 for both).ConclusionsLD worsened the outcomes after cardiac surgery. It increased rates of complications, hospital mortality, length of stay and total hospital charges after both procedures.

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“…Early interventions and internal fixations have been associated with reduced LOS in patients with hip fractures [23]. Improving patients’ renal function [24] as well as pulmonary function have been associated with shorter LOS in patients undergoing cardiac surgery [25]. Increasing hospital volume has been associated with a reduced LOS [26].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with length of stay following trans-catheter aortic valve replacement - a multicenter study

Arbel

Zivkovic

Mehta

et al. 2017

BMC Cardiovasc Disord

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BackgroundMost patients undergoing Transcatheter aortic valve implantation (TAVR) are elderly with significant co-morbidities and there is limited information available regarding factors that influence length of stay (LOS) post-procedure. The aim of this study was to identify the patient, and procedural factors that affect post-TAVR LOS using a contemporary multinational registry.MethodsWe conducted a retrospective cohort study, with patients recruited from three high volume tertiary institutions. The primary outcome was the LOS post-TAVR procedure. We examined patient and procedural factors in a cause-specific Cox multivariable regression model to elucidate their effect on LOS, accounting for the competing risk of post-procedural death. Hazard ratios (HR) greater than 1 indicate a shorter LOS, while HRs less than 1 indicate a longer LOS.ResultsThe cohort consisted of 809 patients. Patient factors associated with longer LOS were older age, prior atrial fibrillation, and greater patient urgency. Patient factors associated with shorter LOS were lower NYHA class, higher ejection fraction and higher mean aortic valve gradients.Procedural characteristics associated with shorter LOS were conscious sedation (HR = 1.19, 95% CI 1.06–1.35, p = 0.004). Transapical access was associated with prolonged LOS (HR = 0.49, 95% CI 0.41–0.58, p < 0.001).ConclusionThis multicenter study identified potentially modifiable patient and procedural factors associated with a prolonged LOS. Future research is needed to determine if interventions focused on these factors will translate to a shorter LOS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0573-7) contains supplementary material, which is available to authorized users.

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Preoperative Renal Function Predicts Hospital Costs and Length of Stay in Coronary Artery Bypass Grafting

Cited by 24 publications

References 24 publications

Renal Disease is Associated with Poor Outcomes Following Isolated Coronary Artery Bypass Grafting

Renal Disease is Associated with Poor Outcomes Following Isolated Coronary Artery Bypass Grafting

The effect of preoperative liver dysfunction on cardiac surgery outcomes

Factors associated with length of stay following trans-catheter aortic valve replacement - a multicenter study

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