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Hospital and Clinician Practice Variation in Cardiac Surgery and Postoperative Acute Kidney Injury
Michael R Mathis1,2, Graciela B Mentz1, Jie Cao3
1Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
JAMA Network Open
|May 2, 2025
Summary
Hospital and clinician practices during cardiac surgery show significant variation, impacting acute kidney injury (AKI) rates. Higher inotrope use increased AKI risk, while higher red blood cell transfusion rates decreased it.
Area of Science:
- Nephrology
- Cardiology
- Anesthesiology
- Health Services Research
Background:
- Acute kidney injury (AKI) affects approximately 30% of US patients post-cardiac surgery, increasing morbidity, mortality, and costs.
- Significant variation exists in hospital and clinician operating room practices, but their impact on AKI is not well understood.
Purpose of the Study:
- To quantify variations in hemodynamic and resuscitative practices among clinicians and hospitals during cardiac surgery.
- To identify associations between these practices and the development of AKI.
Main Methods:
- A cohort study analyzed integrated data from 23,389 adult patients undergoing cardiac surgery across 8 US hospitals.
- Practices evaluated included inotrope/vasopressor infusions, red blood cell (RBC) transfusion, and fluid administration.
- Multilevel mixed-effects models were used to assess the association between practices and AKI, adjusting for patient characteristics.
Main Results:
- AKI developed in 20.4% of patients, with significant variation in AKI rates across hospitals and clinicians.
- Clinician and hospital-level variations were notable for inotrope, vasopressor, RBC transfusion, and fluid administration practices.
- Higher hospital inotrope infusion rates were associated with increased AKI risk (AOR 1.98), while higher clinician RBC transfusion rates were associated with decreased AKI risk (AOR 0.89).
Conclusions:
- Substantial hospital- and clinician-level variations in perioperative practices exist during cardiac surgery.
- These practice variations are associated with AKI development, highlighting potential targets for quality improvement initiatives.
- Further research and standardized protocols may help mitigate AKI risk post-cardiac surgery.
