Percentage of patients undergoing an open cardiac procedure with more than a 1.5x increase in baseline creatinine 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 cardiac surgery with an estimated incidence rate around 20-30%.^1-3 Of patients developing AKI after cardiac surgery, 2-5% require renal replacement therapy postoperatively and the five-year risk of death increases more than two-fold.^1,2 AKI is known to increase patient care demands, significantly increasing hospital cost, length of stay, and mortality.^3-5 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.⁶ This measure most closely aligns with KDIGO AKI criteria, with exceptions of not considering postoperative urine output or renal replacement therapy components of the definition (data are commonly unavailable in the postoperative period).

Up to 7 days after Anesthesia End

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac value code: 1).

• ASA 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 (MPOG Complication: AKI value = -1).
• 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.
• Liver Transplants 
• Open cardiac procedures performed in conjunction with: 
  • Procedures affecting the kidney, bladder, or ureter:
    • Anesthesia CPT: 00862, 00864, 00870, 00872, 00873, 00865, 00908, 00910, 00912, 00914, 00916, 00918, 00860, 00942, 00868 
    • Surgical CPT Codes *See other measure build details.

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.

For patients with more than one case in a 7-day period, postoperative creatinine values only apply to a single case. For example, if a creatinine value is available between the end of the first case and start of the second case, that value will only apply to the first case. If additional values result within the 7-day time period after the second case, those values will not be attributed to the first case. 

Method for calculating EGFR dependent on age and sex data. If sex is not available, phenotype assumes female. Height is required for calculating eGFR for pediatric patients. See Preop EGFR (most recent) for calculation.

Only preop creatinine values ≥0.2 mg/dL and ≤25.00 mg/dL will be considered for pediatric patients <18 years.

Only preop creatinine values ≥0.3 mg/dL and ≤25.00 mg/dL will be considered for adult patients ≥18 years.

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 if listed in conjunction with the open cardiac procedure:

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

Coming soon!

All providers signed in for at least 60 minutes will be attributed. 

If a provider is signed in for less than 60 minutes, the provider will be excluded. If there are no providers signed in for at least 60 minutes, no providers will be attributed for the case.

1. Hansen MK, Gammelager H, Mikkelsen MM, Hjortdal VE, Layton JB, Johnsen SP, Christiansen CF: Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study. Crit Care 2013; 17:R292
2. Howitt SH, Grant SW, Caiado C, Carlson E, Kwon D, Dimarakis I, Malagon I, McCollum C: The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study. BMC Nephrol 2018; 19:149
3. Cheruku SR, Raphael J, Neyra JA, Fox AA: Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management. Anesthesiology 2023; 139:880–98
4. Hu J, Chen R, Liu S, Yu X, Zou J, Ding X: Global Incidence and Outcomes of Adult Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2016; 30:82–9
5. Engoren M, Habib RH, Arslanian-Engoren C, Kheterpal S, Schwann TA: The effect of acute kidney injury and discharge creatinine level on mortality following cardiac surgery*. Crit Care Med 2014; 42:2069–74
6. Kalender M, Adademir T, Çevirme D, Atay M, Boyacioglu K, Tasar M, Buyukbayrak F: Validation of Renal Risk Score Models for Coronary Artery Bypass Surgery in Diabetic Patients. Heart Lung Circ 2019; 28:800–6