Effect of preoperative mild renal dysfunction on mortality and morbidity following valve cardiac surgery

Gracia, Jorge; Riera, María; Ibarra, J.I. Sáez de; Carrillo, Andrés; Fernández, Ruben González; Herrero, Jaime; Fiol, Miguel; Bonnín, Oriol

doi:10.1510/icvts.2007.159392

Cited by 29 publications

(20 citation statements)

References 15 publications

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“…In our study, renal failure increased the risk of pocket hematomas by 60%. Renal dysfunction has been shown to increase the risk of bleeding complications in patients undergoing cardiac procedures and is thought to be mainly due to platelet dysfunction from uremia [15], [16], [17]. Therefore patients with congestive heart failure and renal failure may need closer monitoring after the ICD implantation.…”

Section: Discussionmentioning

confidence: 99%

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Sridhar

Yarlagadda

Kanmanthareddy

et al. 2016

Indian Pacing and Electrophysiology Journal

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BackgroundPocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation.MethodsData from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes. We then identified the patients who experienced a procedure related hematoma during the hospital stay. We compared the outcomes of the patients with and without a hematoma complication. All analyses were performed using SPSS 20 complex samples using appropriate weights to adjust for the complex sampling design of the national database.ResultsOut of a total of 85,276 primary ICD implantations in the year 2010, 2233 (2.6% of the implantations) were complicated by a hematoma. Increased age (p < 0.001), and comorbidities such as congestive heart failure (odds ratio (OR) – 1.86, p < 0.001), coagulopathy (OR - 2.3, p < 0.001) and renal failure (OR - 1.52, p < 0.001) were associated with an increased risk of pocket hematoma formation. Patients who developed a hematoma had a longer hospitalization (9.1 days versus 5.5 days, p < 0.001) and higher in-hospital costs ($56,545 versus $47,015, p < 0.001) compared to patients who did not have a hematoma. Overall mortality associated with ICD implantation was low (0.6%), and hematoma formation did not adversely affect mortality (0.6% versus 0.4%, p = 0.63).ConclusionHematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.

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Section: Discussionmentioning

confidence: 99%

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Sridhar

Yarlagadda

Kanmanthareddy

et al. 2016

Indian Pacing and Electrophysiology Journal

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“…[2122] Consequently, the readmission of these patients in the ICU in order to achieve clinical stability and safety is rather reasonable.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece

Giakoumidakis¹,

Eltheni²,

Patelarou³

et al. 2014

Ann Thorac Med

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INTRODUCTION:Readmission in the intensive care unit (ICU) is a significant morbidity index, which has been related to poor patient outcomesAIM:To identify the preoperative and intraoperative risk factors for readmission in the cardiac surgery ICU.METHODS:We conducted a retrospective cohort study of 595 consecutive patients who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens — Greece during the one-year period (September 2011-September 2012). Data collection was carried out, retrospectively, by the use of a short questionnaire and based on the review of medical and nursing patient records at December 2012.RESULTS:The incidence of ICU readmission was 3.7% (22/595). Respiratory disorders were the main reason for readmission (45.4%). Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (P < 0.001). Multivariate analysis revealed that female gender [for males odds ratio (OR) 0.37, 95% confidence interval (CI) 0.15-0.89], high logistic EuroSCORE (OR 1.02, 95% CI 1.00-1.04), prolonged cardiopulmonary (CPB) duration (OR 1.01, 95% CI 1.00-1.02) and preoperative renal failure (OR 1.02, 95% CI 1.00-1.05) were the independent risk factors for readmission to the cardiac surgery ICU.CONCLUSIONS:One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation.

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“…AKI develops in 1% to 30% of these patients, depending on the definition used for AKI [4], and leads to renal replacement therapy (RRT) in 1% to 5% [5]. Previous reports have studied risk factors associated with the occurrence of AKI, mainly focusing on factors measurable before surgery [6,7] or during the perioperative period [1]. However, postoperative management in the intensive care unit (ICU) could also be relevant for the occurrence of AKI after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification

et al. 2013

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IntroductionThe development of acute kidney injury (AKI) is associated with poor outcome. The modified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification for AKI, which classifies patients with renal replacement therapy needs according to RIFLE failure class, improves the predictive value of AKI in patients undergoing cardiac surgery. Our aim was to assess risk factors for post-operative AKI and the impact of renal function on short- and long-term survival among all AKI subgroups using the modified RIFLE classification.MethodsWe prospectively studied 2,940 consecutive cardiosurgical patients between January 2004 and July 2009. AKI was defined according to the modified RIFLE system. Pre-operative, operative and post-operative variables usually measured on and during admission, which included main outcomes, were recorded together with cardiac surgery scores and ICU scores. These data were evaluated for association with AKI and staging in the different RIFLE groups by means of multivariable analyses. Survival was analyzed via Kaplan-Meier and a risk-adjusted Cox proportional hazards regression model. A complete follow-up (mean 6.9 ± 4.3 years) was performed in 2,840 patients up to April 2013.ResultsOf those patients studied, 14% (n = 409) were diagnosed with AKI. We identified one intra-operative (higher cardiopulmonary bypass time) and two post-operative (a longer need for vasoactive drugs and higher arterial lactate 24 hours after admission) predictors of AKI. The worst outcomes, including in-hospital mortality, were associated with the worst RIFLE class. Kaplan-Meier analysis showed survival of 74.9% in the RIFLE risk group, 42.9% in the RIFLE injury group and 22.3% in the RIFLE failure group (P <0.001). Classification at RIFLE injury (Hazard ratio (HR) = 2.347, 95% confidence interval (CI) 1.122 to 4.907, P = 0.023) and RIFLE failure (HR = 3.093, 95% CI 1.460 to 6.550, P = 0.003) were independent predictors for long-term patient mortality.ConclusionsAKI development after cardiac surgery is associated mainly with post-operative variables, which ultimately could lead to a worst RIFLE class. Staging at the RIFLE injury and RIFLE failure class is associated with higher short- and long-term mortality in our population.

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Effect of preoperative mild renal dysfunction on mortality and morbidity following valve cardiac surgery

Cited by 29 publications

References 15 publications

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece

Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification

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