Percentage of cases 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
• 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
• Non-Operative 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
• 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 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.
• Case duration less than 45 minutes. See ‘Other Measure Build Details’ for Case Duration algorithm.
• Cases where the ‘Anesthesia End Time’ precedes ‘Anesthesia 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)):

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

Pediatric Patients < 18 years old

• Use Bedside Schwartz
  • eGFR = 0.413 * (height in cm) / (baseline creatinine)

The AKI stage definitions are listed below and can also be viewed in detail here: AKI Phenotype Specification

• Stage 1
  • Highest serum creatinine recorded within 48 hours after Anesthesia End is ≥ 0.3 mg/dL higher than baseline creatinine
  • Highest Postop Creatinine recorded within 7 days after Anesthesia End is ≥ 1.5x baseline creatinine
• Stage 2
  • Highest Postop Creatinine recorded within 7 days after Anesthesia End is ≥ 2.0x baseline creatinine
• Stage 3
  • Highest Postop Creatinine recorded within 7 days after Anesthesia End is ≥ 3.0x baseline creatinine OR > 4.0 mg/dL

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.