An Investigation of the Association Between Hospital Characteristics and Acute Kidney Injury After Cardiac Surgery

• Activity Number: 353
• Type: Contributed
• Date/Time: Tuesday, August 5, 2014 : 10:30 AM to 12:20 PM
• Sponsor: Section on Statistics in Epidemiology
• Author(s): Masoumeh Sanagou*+ and Kevan Polkinghorne and Christopher Michael Reid and David Pilcher and Rory Wolfe
• Companies: Monash University and Monash University and Monash University and Monash University and Monash University
• Keywords: Hierarchichal data ; hospital-level characteristics ; GEE ; Logistic regression

Abstract

Objective: To quantify association between hospital-level characteristics and acute kidney injury, AKI, rates after cardiac surgery. Methods: 44,652 patients underwent cardiac surgery in 2001-2011 in 16 Australian hospitals. Patient-level AKI outcomes were related to hospital-level characteristics in a logistic regression model adjusting for patient-level characteristics and fit using generalized estimating equations allowing for clustering by hospital. Results: Cumulative incidence of AKI varied from 0.8% to 8.2% across hospitals. The incidence of AKI was higher among hospitals that had a presence of nephrology expertise (adjusted odds ratio= 1.7, 95% CI : 1.2 to 2.3, p-value=0.001). Other hospital-level characteristics including hospital volume, number of hospital beds, registered nurses per 100 ICU admissions, registered nurses per ICU available bed, hospital available beds, hospital physical beds exhibited no significant association with AKI incidence. Conclusions: Presence of nephrology expertise was associated with AKI incidence following cardiac surgery. Reduced AKI rates would improve patient outcomes and potentially save health system resources.