1. Contemporary trend of acute kidney injury incidence and incremental costs among US patients undergoing percutaneous coronary procedures.
- Author
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Prasad A, Rosenthal NA, Kartashov A, Knish K, and Dreyfus J
- Subjects
- Acute Kidney Injury economics, Acute Kidney Injury therapy, Aged, Aged, 80 and over, Cardiac Catheterization adverse effects, Cardiac Catheterization economics, Coronary Angiography adverse effects, Coronary Angiography economics, Databases, Factual, Female, Hospital Costs trends, Humans, Incidence, Length of Stay economics, Length of Stay trends, Male, Middle Aged, Patient Readmission economics, Patient Readmission trends, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention economics, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, Acute Kidney Injury epidemiology, Cardiac Catheterization trends, Coronary Angiography trends, Health Care Costs trends, Percutaneous Coronary Intervention trends
- Abstract
Objectives: To assess national trends of acute kidney injury (AKI) incidence, incremental costs, risk factors, and readmissions among patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) during 2012-2017., Background: AKI remains a serious complication for patients undergoing CAG/PCI. Evidence is lacking in contemporary AKI trends and its impact on hospital resource utilization., Methods: Patients who underwent CAG/PCI procedures in 749 hospitals were identified from Premier Healthcare Database. AKI was defined by ICD-9/10 diagnosis codes (584.9/N17.9, 583.89/N14.1, 583.9/N05.9, E947.8/T50.8X5) during 7 days post index procedure. Multivariable regression models were used to adjust for confounders., Results: Among 2,763,681 patients, AKI incidence increased from 6.0 to 8.4% or 14% per year in overall patients; from 18.0 to 28.4% in those with chronic kidney disease (CKD) and from 2.4 to 4.2% in those without CKD (all p < .001). Significant risk factors for AKI included older age, being uninsured, inpatient procedures, CKD, anemia, and diabetes (all p < .001). AKI was associated with higher 30-day in-hospital mortality (OR
adjusted = 2.55; 95% CI: 2.40, 2.70) and readmission risk (ORadjusted = 1.52; 95% CI: 1.50, 1.55). The AKI-related incremental cost during index visit and 30-day readmissions were estimated to be $8,416 and $580 per inpatient procedure and $927 and $6,145 per outpatient procedure. Overall excess healthcare burden associated with AKI was $1.67 billion., Conclusions: AKI incidence increased significantly in this large, multifacility sample of patients undergoing CAG/PCI procedures and was associated with substantial increase in hospital costs, readmissions, and mortality. Efforts to reduce AKI risk in US healthcare system are warranted., (© 2020 Wiley Periodicals, Inc.)- Published
- 2020
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