Lesão Renal no Pós-Operatório de Cirurgia Cardíaca: Redução de Custos Associada à Prevenção
DOI:
https://doi.org/10.20344/amp.18755Palavras-chave:
Biomarcadores, Custos Hospitalares, Fatores de Risco, Lesão Renal Aguda/económica, Lesão Renal Aguda/etiologia, Procedimentos Cirúrgicos Cardíacos/efeitos adversosResumo
Introdução: A cirurgia cardíaca pode induzir lesão renal aguda e levar à necessidade de terapêutica de substituição renal. A esta cirurgia associam-se também maiores custos hospitalares, morbilidade e mortalidade. Os objetivos deste estudo foram investigar os preditores de lesão renal aguda associada a cirurgia cardíaca na nossa população e determinar o impacto da lesão renal aguda na cirurgia cardíaca eletiva. Avaliou-se também o potencial custo-efetividade da sua prevenção através da aplicação do Kidney Disease: Improving Global Outcomes bundle of care a grupos de doentes de alto risco identificados pelo [TIMP-2]x[IGFBP7] como teste de rastreio.
Material e Métodos: Foi realizado um estudo retrospetivo num centro hospitalar universitário, onde foi analisada uma amostra consecutiva de adultos que foram submetidos a cirurgia cardíaca eletiva entre janeiro e março de 2015. Durante o período do estudo, foram admitidos no total 276 doentes. Os dados de todos os doentes foram analisados até à alta hospitalar ou morte do doente. Foi realizada uma análise económica da perspetiva de custos para o hospital.
Resultados: Oitenta e seis doentes (31%) desenvolveram lesão renal aguda no pós-operatório de cirurgia cardíaca. Após ajuste, os valores elevados de creatinina sérica pré-operatória (mg/L, ORadj = 1,09; IC 95%: 1,01 – 1,17), hemoglobina pré-operatória baixa (g/dL, ORadj = 0,79; IC 95%: 0,67 – 0,94), hipertensão arterial sistémica crónica (ORadj = 5,00; IC 95%: 1,67 – 15,02), tempo prolongado de circulação extra-corporal (min, ORadj = 1,01; IC 95%: 1,00 – 1,01) e o uso perioperatório de nitroprussiato de sódio (ORadj = 6,33; IC 95%: 1,80 – 22,28) mantiveram-se significativamente associados a lesão renal aguda no pós-operatório de cirurgia cardíaca. O custo cumulativo foi de €120 695,84. Baseando-nos numa redução de risco absoluta de 16,6%, ao dosear os biomarcadores de lesão renal estrutural em todos os doentes juntamente com medidas preventivas de lesão renal aguda nos doentes de alto risco, esperaríamos um ponto de equilíbrio ao tratar 78 doentes, que se traduziria, na nossa coorte, num benefício total de custos de €7145.
Conclusão: A hemoglobina pré-operatória, creatinina sérica, hipertensão sistémica, tempo de bypass cardiopulmonar e o uso perioperatório de nitroprussiato de sódio foram preditores independentes de lesão renal aguda associada a cirurgia cardíaca. O nosso modelo de custo-efetividade sugere que o uso de biomarcadores renais em combinação com estratégias preventivas precoces poderá estar relacionado com uma potencial poupança de custos.
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