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Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD
Babak Bohlouli1, Terri Jurgens Jackson2,3, Marcello Tonelli4
1Department of Medicine, University of Alberta, Edmonton, Alberta.
Insights
Preventable hospital-acquired complications (HACs) significantly increase mortality and length of stay for patients with chronic kidney disease (CKD). Reducing these HACs is crucial for improving patient outcomes and reducing healthcare burdens.
Area of Science:
- Nephrology
- Hospital Quality Improvement
- Patient Safety
Background:
- Patients with chronic kidney disease (CKD) face elevated risks for hospital-acquired complications (HACs).
- Understanding the impact of preventable HACs on CKD patient outcomes is critical for targeted interventions.
Purpose of the Study:
- To investigate the association between preventable HACs and mortality, length of stay (LOS), and readmission rates in hospitalized patients.
- To specifically examine these associations within the CKD population.
Main Methods:
- Retrospective analysis of adult hospitalizations in Alberta from April 2003 to March 2008.
- CKD defined by eGFR <60 ml/min/1.73 m² and/or albumin-to-creatinine ratio >3-30 mg/mmol.
- Regression models used to assess the impact of preventable HACs on mortality, LOS, and readmission.
Main Results:
- 8.5% of hospitalizations involved patients with CKD; 9.8% of these had preventable HACs.
- Preventable HACs were associated with a 4.67-fold increased odds of in-hospital mortality for CKD patients.
- Incremental LOS was 9.86 days, and readmission odds increased by 1.24 for patients with preventable HACs.
Conclusions:
- Preventable HACs significantly elevate mortality, lengthen hospital stays, and increase readmission risks, particularly for individuals with CKD.
- Implementing targeted strategies to mitigate HACs in CKD patients is a high-priority healthcare objective.
Background:
and objectives Patients with CKD are at risk of hospital-acquired complications (HACs). We sought to determine the association of preventable HACs with mortality, length of stay (LOS), and readmission.
Design, Setting, Participants, & Measurements:
All adults hospitalized from April of 2003 to March of 2008 in Alberta were characterized by kidney function and occurrence of preventable HACs. CKD was defined by eGFR<60 ml/min per 1.73 m2 and/or albumin-to-creatinine ratio >3-30 mg/mmol for >3 months in the time frame from 365 to 90 days before admission. Regression models examined the association of HACs with outcomes.
Results:
Of 536,549 hospitalizations, 8.5% (n=45,733) had CKD and 9.8% of patients with CKD had one or more potentially preventable HAC. In patients with potentially preventable HACs, proportions of death within index hospitalization and from discharge to 90 days were 17.7% and 6.8%, respectively. In patients with CKD, comparing with those hospitalizations without potentially preventable HACs, the adjusted odds ratio (OR) of mortality during index hospitalization and from hospital discharge to 90 days in patients with one or more preventable HAC was 4.67 (95% confidence interval [95% CI], 4.17 to 5.22) and 1.08 (95% CI, 0.94 to 1.25), respectively. Median incremental LOS in patients with one or more preventable HAC was 9.86 days (95% CI, 9.25 to 10.48). The OR for readmission with preventable HAC was 1.24 (95% CI, 1.15 to 1.34). In a cohort with and without CKD, the adjusted ORs of mortality during index hospitalization in patients with CKD and no preventable HACs, patients without CKD and with preventable HACs, and patients with CKD and preventable HACs were 2.22 (95% CI, 1.69 to 2.94), 5.26 (95% CI, 4.98 to 5.55), and 9.56 (95% CI, 7.23 to 12.56), respectively (referenced to patients without CKD or preventable HACs).
Conclusions:
Preventable HACs are associated with higher mortality, incremental LOS, and greater risk of readmission, especially in people with CKD. Targeted strategies to reduce complications should be a high priority.
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