Measure Abbreviation
AKI-01
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.

Measure Type
Outcome
Description
  • Percentage of cases that the baseline creatinine does not increase more than 1.5 times within 7 postoperative days or the baseline creatinine level does not increase by = 0.3 mg/dL within 48 hours postoperatively.
Inclusions

All anesthetic cases.

Exclusions
  • ASA 5 & 6
  • Patients with pre-existing renal (stage 4 or 5) failure based upon BSA-Indexed EGFR < 30 mL/min/1.73m^2
  • 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 o
    • Renal & Liver Transplants – CPT 00868, 00796
  • Non-Operative Procedures:
    • Obstetric Non-Operative Procedures – CPT 01958, 01960, 01967
    • Pain Procedures – CPT 01991, 01992, 01996
    • Electroconvulsive Therapy – CPT 00104
  • Patients where a creatinine lab is not available within 7 postoperative days.
  • Patients that do not have a baseline creatinine within 60 days preoperatively.
  • For patientswith 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.
  • Case duration less than 45 minutes. See ‘Other Measure Build Details’ for Case Duration algorithm.
Success

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.

Other Measure Build Details

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:

Adult patients >18 years old:

  • Sites with race data: CKD-EPI EGFR = 141 x min(Scr/κ, 1)α x max(Scr/κ, 1)-1.209 x (0.993)Age x (1.018 if female) x (1.159 if black)
    • Scr indicates the serum creatinine in mg/DL
    • κ = 0.7 for females, 0.9 for males; for missing gender data, assume female
    • α = -0.329 for females, -0.411 for males; for missing gender data, assume female
    • Age = age in years  
    • min indicates the minimum of Scr/κ or 1
    • max indicates the maximum of Scr/κ or 1
Responsible Provider
  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.
Threshold
≤10%
MPOG Concept IDs Required

Creatinine Lab Concept ID

  • 5002 Formal lab - Creatinine, Serum/Plasma

Ht/Wt MPOG Concept IDs

  • 70257 Physical Exam - Height (cm)
  • 70258 Physical Exam - Height (in)
  • 70264 Physical Exam - Weight (kg)
  • 70265 Physical Exam - Weight (lb)

Race MPOG Concept IDs modified

  • 4000 Unknown Race
  • 4001 Hispanic, White
  • 4002 Hispanic, Black
  • 4003 Hispanic, Color Unknown
  • 4004 Black, not of Hispanic Origin
  • 4005 White, not of Hispanic Origin
  • 4006 American Indian or Alaska Native
  • 4007 Asian or Pacific Islander
  • 4008 Bi or Multi Racial
  • 4009 Middle Eastern
  • 4050 Other Race Not Listed
  • 18117 Column Mapping - AIMS_Race_Text
Rationale

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.

Risk Adjustment

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.

References
  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.