Percentage of patients that the baseline creatinine increases more than 1.5 times within 7 postoperative days or the baseline creatinine level increases by = 0.3 mg/dL within 48 hours postoperatively.

Acute kidney injury is a serious complication following non-cardiac surgery and is associated with an increased risk of in-hospital mortality. The development of AKI is known to increase patient care demands, accounting for 20% of intensive care unit (ICU) admissions, and significantly increasing hospital cost, length of stay, and mortality. Definitions and classification schema for AKI vary across current literature; most commonly, these include the Risk/Injury/Failure/Loss/End-stage (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease-Improving Global Outcomes (KDIGO) criteria. This measure most closely aligns with KDIGO AKI criteria, with exceptions of: a) not considering postoperative urine output or renal replacement therapy components of the definition (data are commonly unavailable); b) not considering cases in which a ≥ 0.3 mg/dL increase in serum creatinine level occurred greater than 48 hours but less than 7 days postoperative.

Up to 48 hours postoperatively.

All anesthetic cases.

• ASA 5 & 6 including Organ Harvest (CPT:01958)
• For patients with more than one case in a 7-day period, the first case will be excluded if apostop creatinine is not documented for that first case. For example, a patient that has surgery twice in a 7-day period, the first surgery is excluded if a creatinine is not drawn in between cases.
• Patients with pre-existing renal (stage 4 or 5) failure based upon BSA-Indexed EGFR < 30 mL/min/1.73m^2 determined by Preop EGFR (most recent)
• Patients undergoing procedures affecting kidneys
  • Urologic surgery on kidney/ureter – CPT 00862, 00864, 00870, 00872, 00873, 00865, 00908, 00910, 00912, 00914, 00916, 00918, 00860, 00942 
  • Renal & Liver Transplants – CPT 00868, 00796
  • Surgical CPT: 35480, 35535, 35634, 35636, 37145, 37180, 37181, 50010, 50020, 50021, 50040, 50045, 50060, 50065, 50070, 50075, 50080, 50081, 50120, 50125, 50130, 50135, 50200, 50205, 50220, 50225, 50230, 50234, 50236, 50240, 50250, 50280, 50290, 50340, 50360, 50365, 50370, 50380, 50382, 50384, 50385, 50386, 50387, 50390, 50392, 50393, 50395, 50400, 50405, 50500, 50520, 50525, 50540, 50541, 50542, 50543, 50544, 50545, 50546, 50548, 50551, 50553, 50555, 50557, 50561, 50562, 50570, 50572, 50574, 50575, 50576, 50580, 50590, 50592, 50593, 50600, 50605, 50610, 50620, 50630, 50650, 50660, 50688, 50700, 50715, 50722, 50725, 50727, 50728, 50740, 50750, 50760, 50770, 50780, 50782, 50783, 50785, 50810, 50815, 50830, 50840, 50845, 50860, 50900, 50920, 50930, 50940, 50945, 50947, 50948, 50951, 50953, 50955, 50957, 50961, 50970, 50972, 50974, 50976, 50980, 51020, 51030, 51040, 51045, 51050, 51060, 51065, 51080, 51500, 51520, 51525, 51530, 51535, 51550, 51555, 51565, 51570, 51575, 51580, 51585, 51590, 51595, 51596, 51600, 51605, 51610, 51700, 51701, 51703, 51715, 51720, 51725, 51726, 51727, 51728, 51729, 51736, 51741, 51784, 51785, 51792, 51800, 51820, 51840, 51841, 51845, 51860, 51865, 51880, 51900, 51920, 51925, 51940, 51980, 52000, 52001, 52005, 52007, 52010, 52204, 52214, 52224, 52234, 52235, 52240, 52250, 52260, 52265, 52270, 52275, 52276, 52277, 52281, 52282, 52283, 52285, 52290, 52300, 52301, 52305, 52310, 52315, 52317, 52318, 52320, 52325, 52327, 52330, 52332, 52334, 52341, 52342, 52343, 52344, 52345, 52346, 52351, 52352, 52353, 52354, 52355, 52400, 52402, 52450, 52500, 52601, 52630, 52640, 52647, 52648, 52649, 52700, 53060, 53200, 53210, 53215, 53230, 53270, 53275, 53430, 53431, 53445, 53446, 53447, 53448, 53449, 53500, 53502, 53600, 53601, 53605, 53620, 53621, 53660, 53661, 53665, 53850, 53852, 53855, 54390, 55801, 55821, 55831, 57220, 57230, 57240, 57284, 57285, 57310, 57311, 57320, 57330, 57423
• Patients where a creatinine lab is not available within 7 postoperative days.
• Patients that do not have a baseline creatinine within 60 days preoperatively.
• Procedures:
  • Obstetric Non-Operative Procedures – CPT 01958
  • Labor Epidurals as determined by the MPOG 'Obstetric Anesthesia Type' Phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)'
  • Pain Procedures – CPT 01991, 01992, 01996
  • Procedure Type: ECT
• Surgery duration less than 45 minutes. 

*Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'

1. The creatinine level does not go above 1.5x the baseline creatinine within 7 days post-op
2. The creatinine level does not increase by ≥ 0.3 mg/dL obtained within 48 hours after anesthesia end.

Only valid creatinine values (≥0.2 mg/dL and ≤25.00 mg/dL) used. Method for calculating EGFR dependent on age and availability of patient race data (see Preop EGFR (most recent)):

The AKI stage definitions can be viewed in detail here: AKI Phenotype Specification

Risk of progression to CKD is available per case in the 'Measure Case Report Tool'. Further details available here.

To evaluate provider-level risk adjustment we will calculate the observed to expected outcomes ratio (O/E). The O/E is calculated using a logistic regression model and predicts (given a set list of dependent patient and hospital level variables) the expected probability of having a kidney injury. We adjust for surgery risk score, emergent procedures, ASA, gender, age, body mass index, laboratory values, and teaching versus private hospital. Patient specific comorbidities are evaluated as well.

1. The provider signed in during the case when the BP 01 measure failed (it is possible to have more than one provider).
2. If there is no failure for the BP 01 measure, then the responsible provider is the provider signed in the longest.

1. Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Critical care (London, England). 2009;13(3):R79
2. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical care (London, England). Aug 2004;8(4):R204-212.
3. James, Matthew T., Neesh Pannu, Brenda R. Hemmelgarn, Peter C. Austin, Zhi Tan, Eric McArthur, Braden J. Manns, et al. 2017. “Derivation and External Validation of Prediction Models for Advanced Chronic Kidney Disease Following Acute Kidney Injury.” JAMA: The Journal of the American Medical Association 318 (18): 1787–97.