Cardiothoracic & vascular anesthesia
Hospital and Clinician Practice Variation in Cardiac Surgery and Postoperative Acute Kidney Injury
Authors' conclusion
This cohort study of adult patients found that hospital- and clinician-level variation in operating room practices was associated with AKI after cardiac surgery, suggesting possible targets for intervention.
Study context
- Population
- Adults (≥18 years) undergoing cardiac surgery at 8 US hospitals, 2014–2022 (MPOG and STS databases)
- Participants
- 23,389 adults · 8 US hospitals
- Exposure
- Hospital- and clinician-level variation in operating room hemodynamic and resuscitative practices
- Outcome
- Consensus guideline-defined AKI (any stage)
- Follow-up
- Within 7 days after cardiac surgery
Methodological detailsmulticentre, multilevel mixed-effects models, risk-adjusted
- Multicentre
- Multilevel mixed-effects models
- Risk-adjusted
Main finding
As reported in the abstract
AKI after cardiac surgery
- Acute kidney injury (AKI) incidence
- 4779 (20.4%)
- AKI rate across hospitals, median [IQR]
- 21.7% [15.5%-27.2%]
- AKI rate across clinicians, median [IQR]
- 18.1% [10.1%-23.7%]
- Hospitals with higher inotrope infusion rates: higher AKI, aOR
- 1.98 (1.18-3.33; P = .01) (95% CI; P)
- Clinicians with higher RBC transfusion rates: lower AKI, aOR
- 0.89 (0.79-0.99; P = .03) (95% CI; P)
Observational data: associations, not effects.
Further findings
Practice variation, ICC clinician vs hospital level
- Inotrope infusion >60 min, ICC clinician vs hospital
- 6.2% [95% CI, 4.2%-8.0%] vs 17.9% [95% CI, 3.3%-31.9%]
- Vasopressor infusion >60 min, ICC clinician vs hospital
- 11.7% [95% CI, 8.3%-14.9%] vs 44.5% [95% CI, 11.7%-63.5%]
- RBC transfusion, ICC clinician vs hospital
- 1.7% [95% CI, 0.9%-2.6%] vs 4.5% [95% CI, 1.2%-9.4%]
- Fluid volume administration, ICC clinician vs hospital
- 2.1% [95% CI, 1.3%-2.7%] vs 23.8% [95% CI, 2.7%-39.9%]
Original publication
Hospital and Clinician Practice Variation in Cardiac Surgery and Postoperative Acute Kidney Injury. JAMA Netw Open. Published 1 May 2025. doi:10.
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