Measure ID
AKI-01
Domain
Description

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

Measure Type
Outcome
Available for Provider Feedback
Yes
Threshold
≤10%
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. 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.

Measure Time Period

Up to 48 hours after Anesthesia End

Inclusions

All patients requiring anesthesia.

Exclusions
  • ASA 5 & 6 including Organ Procurement (CPT:01990)
  • Cases where a baseline creatinine is not available within 60 days preoperatively
  • Cases where a creatinine lab is not available within 7 postoperative days.
  • Patients with more than one case in a 7-day period. The first case will be excluded if a postop 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) or MPOG Complication - Acute Kidney Injury value code -2.
  • Procedures:
    • ECT
    • Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)
    • Pain Procedures – CPT 01991, 01992, 01996
    • Renal & Liver Transplants – CPT 00868, 00796
    • Procedures affecting the kidney, bladder, or ureter:
      • Anesthesia CPT: 00862, 00864, 00870, 00872, 00873, 00865, 00908, 00910, 00912, 00914, 00916, 00918, 00860, 00942 
      • Surgical CPT Codes *See other measure build details.
  • Surgery duration less than 45 minutes
Success Criteria

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 Details

Only valid creatinine values (≥0.2 mg/dL and ≤25.00 mg/dL) are considered. Method for calculating eGFR is dependent on age and gender data. If gender is not available, phenotype assumes female. Height is required for calculating eGFR for pediatric patients. See Preop EGFR (most recent) for calculation.

The AKI stage definitions can be viewed in detail here: MPOG Complication - Acute Kidney Injury 

AKI- Risk of Progression to CKD Phenotype is available per case in the 'Measure Case Report Tool'. 

The following Surgical CPT Codes are excluded from this measure:

AKI-01 Surgical CPT Code List

Vein Procedures – 35535, 35634, 35636, 37145, 37180, 37181

Incision Procedures on the Kidney – 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 

Renal Transplantation Procedures – 50340, 50360, 50365, 50370, 50380

Renal Pelvis Catheter-Based Procedures – 50382, 50384, 50385, 50386, 50387, 50390, 50392, 50393, 50395

Procedures on the Kidney – 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  

Incision/Biopsy Procedures on the Ureter – 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  

Procedures on the Bladder – 51020, 51030, 51040, 51045, 51050, 51060, 51065, 51080, 51800, 51820, 51840, 51841, 51845, 51860, 51865, 51880, 51900, 51920, 51925, 51940, 51980, 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, 52000, 52001, 52005, 52007, 52010

Urethra/Pelvis/Bladder Transurethral Surgical Procedures – 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  

Incision Procedures on the Urethra – 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

Procedures on the Penis or Prostate – 54390, 55801, 55821, 55831  

Procedures on the Vagina – 57220, 57230, 57240, 57284, 57285, 57310, 57311, 57320, 57330, 57423

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

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.

Provider Attribution
  1. The provider(s) 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(s) is the provider signed in the longest.
MPOG Concept Used

Creatinine Labs

  • 5002 Formal lab - Creatinine, Serum/Plasma

Patient Characteristics

  • 70257 Physical Exam - Height (cm)
  • 70258 Physical Exam - Height (in)
  • 70264 Physical Exam - Weight (kg)
  • 70265 Physical Exam - Weight (lb)
  • 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
MPOG Phenotypes Used
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.
  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.
Measure Authors
 Measure Author  Institution
 Mike Mathis, MD  University of Michigan
 Nirav Shah, MD  University of Michigan
 Jamie Osborne, RN  University of Michigan
 Kate Buehler, MS, RN  University of Michigan
 Anik Sinha  University of Michigan
 MPOG Quality Committee  
Measure Reviewer(s)
Next Review: 2026
 Date Reviewed  Reviewer  Institution  Summary  QC Vote
 11/27/2023  Mike Mathis, MD  University of Michigan  Review  Modify
 10/26/2020

 Mike Mathis, MD

 Mike Aziz, MD

 Bishr Haydar, MD 

 University of Michigan

 OHSU

 University of Michigan

 Review  Continue as is

 

Version
Published: 2017
Date Criteria Revision
Pending Attribution If case flagged for BP-01 and/or BP-03, then attribute provider who was signed into the case when hypotension occurred. Else attribute provider signed in for longest duration of case.
4/11/2023 Exclusion Case Duration < 45 minutes updated to use Surgery Duration algorithm.
9/20/2021  Exclusion Replaced Electroconvulsive Therapy CPT codes with new ECT phenotype
11/1/2019 Exclusion Preop Cr < 0.3 (Adult) or < 0.2 (Pediatric)
6/1/2017   Initial Publication