Determining risk factors of continuous renal replacement treatment after emergency surgery for type A acute aortic dissection: statistical issues

Abstract

This letter to the editor has made several comments regarding possible statistical issues in recent article by Wang et al. determining the risk factors of continuous renal replacement treatment after emergency surgery for type A acute aortic dissection, which is published in Journal of Cardiothoracic Surgery. 2020; 15(1):100. Our comments were involved in the issues of using the propensity score matched cohorts to adjust the covariates that can potentially confound the primary outcomes, process of establishing multivariate model and application of Kaplan-Meier curve analysis in this retrospective study. We would like to remind readers to pay special attention to these issues and invite the authors to comment on these.

Acute renal failure after acute type A aortic dissection repair. Insidious postoperative complication with poor short‐ and long‐term prognosis

“…Postoperative ARF creates a risk factor for immediate and late renal replacement therapy (RRT) which will affect the overall survival of patients who are treated for ATAAD repair. 11, [15][16][17][18][19] Brown et al presented the effect of ARF on the long-term survival of patients who were operated on for ATAAD under hypothermic circulatory arrest (HCA). 1 The observational study were at risk for the development of postoperative ARF.…”

“…Recently, many studies have included postoperative ARF as the end-point for primary outcomes of patients with ATTAD. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] From May 2020 to October 2021 over 10 studies have been published with this end-point. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The incidence of postoperative ARF was 10.5%-68.1%.…”

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] From May 2020 to October 2021 over 10 studies have been published with this end-point. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The incidence of postoperative ARF was 10.5%-68.1%. 15,18,20,[22][23][24][25][26][28][29][30] The most common predisposing factors for postoperative ARF were preoperative renal dysfunction, RBC transfusion unit, preoperative malperfusion syndrome, and duration of CPB time.…”

“…Additional risk factor for worse long‐term survival is the development of postoperative acute renal failure (ARF). Postoperative ARF creates a risk factor for immediate and late renal replacement therapy (RRT) which will affect the overall survival of patients who are treated for ATAAD repair 11,15–19 …”

“…Recently, many studies have included postoperative ARF as the end‐point for primary outcomes of patients with ATTAD 15–29 . From May 2020 to October 2021 over 10 studies have been published with this end‐point 15–29 . The incidence of postoperative ARF was 10.5%–68.1% 15,18,20,22–26,28–30 .…”