Same admission cardiac catheterization and cardiac surgery: is there an increased incidence of acute kidney injury?
Document Type
Article
Publication Date
11-1-2010
Journal Title
The Annals of thoracic surgery
MeSH Headings
Acute Kidney Injury, Adult, Aged, Cardiac Catheterization, Cardiac Surgical Procedures, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies
Abstract
BACKGROUND: Acute kidney injury (AKI) is predictive of increased long-term mortality after cardiac surgery. Patients often undergo surgery after cardiac catheterization during the same admission for reasons of instability and threatening anatomy as well as nonurgent reasons such as patient convenience. We hypothesized that patients undergoing cardiac catheterization and cardiac surgery during the same admission are more likely to develop AKI after cardiac surgery than patients for whom surgery is performed on a later admission.
METHODS: We prospectively enrolled 668 nonemergent adult cardiac surgical cases. Patients having heart catheterization were divided into two groups: cardiac catheterization followed by cardiac surgery during the same hospital admission (same admission) or catheterization followed by surgery during a later admission (later admission). The AKI was defined by an increase in serum creatinine from baseline by 50% or greater or 0.3 (mg/dL) or greater. Univariable and multivariable logistic regression and propensity-matched analyses were conducted.
RESULTS: The incidence of AKI was significantly higher in the patients who had same admission cardiac catheterization and surgery (50.2%) compared with patients who had surgery on a later admission (33.7%, p = 0.009). The adjusted odds ratio for surgery on a later admission was 1.54 (95% confidence interval: 1.11 to 2.13) suggesting a 54% increased risk of AKI. Propensity-matched results were similar with 1.58 (95% confidence interval: 1.13 to 2.22).
CONCLUSIONS: When cardiac catheterization and cardiac surgery occur during the same hospitalization, there is an increased risk for postoperative AKI. After cardiac catheterization, discharge and readmission for nonurgent surgery should be considered as such an approach might reduce the risk of AKI.
ISSN
1552-6259
First Page
1418
Last Page
1423
Recommended Citation
Kramer, Robert S; Quinn, Reed D; Groom, Robert C; Braxton, John H; Malenka, David J; Kellett, Mirle A; Brown, Jeremiah R; and Northern New England Cardiovascular Disease Study Group, "Same admission cardiac catheterization and cardiac surgery: is there an increased incidence of acute kidney injury?" (2010). MaineHealth Maine Medical Center. 902.
https://knowledgeconnection.mainehealth.org/mmc/902