Background Acute kidney injury (AKI) is a common complication following cardiac surgery. While AKI severity is associated with increased risk of short-term outcomes, its long-term impact is less well understood. Methods Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n=1,610). Patients were excluded if they had renal failure (n=15) or died during index admission (n =38). AKI severity was defined using the AKI Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox’s proportional hazard modeling were conducted for time to readmission and death over 5 years. Results Within 5 years, 513 patients (33.8%) developed AKI with AKIN stage 1 (29.9%) and stage 2–3 (3.9%). There were 620 (39.9%) readmissions and 370 (23.8%) deaths. After adjustment, Stage 1 AKI patients had a 31% increased risk of readmission (95%CI: 1.10–1.57), while Stage 2–3 patients had a 98% increased risk (1.41–2.78) compared to those with no AKI. Relative to those without AKI, Stage 1 patients had a 56% increased risk of mortality (1.14–2.13) while those Stage 2–3 patients had a 3.5-times higher risk (2.16–5.60). Conclusions AKI severity using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest efforts to reduce AKI in the perioperative period may have significant long-term impact for patients and payers in reducing mortality and healthcare utilization.

Intraoperative conversion from OPCAB to ONCAB remains a morbid event with a risk of mortality much higher than expected. Surgeons should consider elective ONCAB in those with a high risk for conversion during OPCAB.

StreszczenieWstęp: W rzetelnej ocenie wyników leczenia należy brać pod uwagę różnorodność leczonej populacji pacjentów. Bez uwzględ-nienia tych danych analizowanie, a tym bardziej porównywanie, wyników jest obarczone dużym, nieakceptowalnym błędem. Do analizy śmiertelności po leczeniu wad wrodzonych serca w okresie 16 lat zastosowaliśmy cztery narzędzia do stratyfikacji ich złożoności: Aristotle Basic Complexity Score (ABC Score), Risk Adjustment for Congenital Heart Surgery-1 Categories (RACHS-1 Categories), The Society of Thoracic Surgeons -European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Score (STAT Mortality Score) i STAT Mortality Categories. Celem pracy była nie tylko analiza jednoośrodkowych wyników, lecz także określenie zdolności każdego z zastosowanych narzę-dzi do przewidywania pooperacyjnej śmiertelności. Materiał i metody: W analizie uwzględniono kompletne i zweryfikowane dane dotyczące śmiertelności szpitalnej po 8404 operacjach wykonanych w okresie 16 lat. W ocenie statystycznej użyteczności każdego z testowanych narzędzi wzięto pod uwagę jedynie procedury, które to narzędzie oceniało. Wyniki: Średnia śmiertelność szpitalna wynosiła 4,38% (0-33%). STAT Mortality Score miał najwyższą zdolność prognozowania w określaniu śmiertelności (C-index = 0,768). Współczynnik korelacji Pearsona pomiędzy STAT Mortality Score określonej procedury a rzeczywistą śmiertelnością w prezentowanym w niniejszej pracy materiale wyniósł r = 0,84. W grupie 33 procedur, które były klasyfikowane przez wszystkie cztery narzędzia, zdolność prognozowania była również najwyższa dla STAT Mortality Score (C-index = 0,776). 115 CONGENITAL HEART DISEASE IN CHILDREN AND ADULTS AbstractIntroduction: Meaningful evaluation of the quality of care must account for the variations in the population of patients receiving treatment (''case-mix''). In order to analyze mortality after congenital heart surgery over 16 years, we used four complexity stratification tools: Aristotle Basic Complexity Score (ABC Score), Risk Adjustment for Congenital Heart Surgery-1 Categories (RACHS-1 Categories), The Society of Thoracic Surgeons -European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Score (STAT Mortality Score), and STAT Mortality Categories. Our goal was not only to analyze our institutional results, but also to evaluate the ability of each tool to predict mortality. Material and methods: Complete and verified data on hospital mortalities that occurred after 8404 operations over 16 years in our institution were included in the study. For evaluating the statistical predictability of each tool, we included only those procedures that were scored by that tool. Results: Mean hospital mortality was 4.38%, ranging from 0% to 33%. The STAT Mortality Score had the highest discrimination for predicting mortality (C-index = 0.768). The Pearson correlation coefficient between a procedure's STAT Mortality Score and its actual mortality rate was r = 0.84. In the subset of procedures which could b...

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Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) has dramatically risen in recent years. Children with congenital or acquired heart disease are at particular risk and have not been addressed by recent, novel retrospectively-derived risk scores. Aims: We sought to develop a risk model for HA-VTE in critically-ill children with cardiac disease. Methods: We conducted a retrospective, case-control study of children admitted to the CVICU at All Children's Hospital Johns Hopkins Medicine (St. Petersburg, FL, USA) from January 2006 - April 2013. We identified cases via ICD-9 codes, and employed case validation via review of radiologic records. Two controls were randomly selected for each case. Associations between putative risk factors and HA-VTE were estimated using odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs) from univariate and multivariate logistic regression analyses. Variables with P-values < 0.1 in univariate analyses were included in the multivariate model. A HA-VTE risk score was developed with weighting based on the relative magnitudes of the individual ORs from the multivariate model. Results: After adjustment in a multiple logistic regression, length of stay (LOS) >30 days, cardiac catheterization, and major infection were found to be statistically-significant independent risk factors for HA-VTE in these children. An 8-point risk score was developed in which scores of 0-1, 2-6, and 7-8 yielded HA-VTE risks of < 1%, 1-< 2%, and ≥2%, corresponding to conventional thresholds for instituting no prophylaxis, mechanical prophylaxis, and pharmacological prophylaxis (respectively) in hospitalized adults. Conclusions: LOS >30 days, cardiac catheterization, and major infection are significant independent risk factors for HA-VTE in critically-ill children with cardiac disease leading to the development of a novel HA-VTE risk score in this population. If prospectively validated, this risk score will inform the design of risk-stratified clinical trials of HA-VTE prevention.