Abstract
BackgroundMild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery. However, there is less study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and follow-up outcomes after isolated OPCAB surgery. This single-centre, retrospective propensity score matching study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and long-term outcomes after first isolated OPCAB surgery.MethodsAfter propensity score matching, 1236 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 undergoing first isolated OPCAB surgery from January 2007 to December 2011 were entered into this study and were divided to normal group (eGFR ≥ 90 ml/min/1.73 m2, n = 618) and mild group (eGFR of 60–89 ml/min/1.73 m2, n = 618). The in-hospital and long-term outcomes were investigated and retrospectively analyzed.ResultsThe 2 propensity score-matched groups had similar baseline and procedural characteristics except the baseline eGFR. Thirty-five patients died during the same hospitalization or within 30 days of operation, with a surgical mortality of 2.8 %. Sixty-seven patients died during follow-up, with a long-term survival of 94.1 %. Univariate factor analysis showed that the 2 propensity score-matched groups have similar rates among in-hospital outcomes. Kaplan-Meier curves displayed a similar in-hospital survival between the 2 groups (χ2 = 0.728, p = 0.393), while a better long-term survival in patients with normal preoperative renal function compared with mild preoperative renal insufficiency (χ2 = 4.722, p = 0.030). After Cox proportional model was used, the hazard ratio for long-term mortality in patients with mild preoperative renal insufficiency compared with normal preoperative renal function was 1.72 (95 % CI 1.06–2.83, p = 0.032).ConclusionsMild preoperative renal insufficiency compared with normal preoperative renal function reduced long-term survival, without evidence of worse in-hospital outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-016-0422-2) contains supplementary material, which is available to authorized users.
Highlights
Mild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery
Based on the above analysis, employing estimated glomerular filtration rate (eGFR) calculated by Cockcroft-Gault formula as an index of preoperative renal function, we reviewed 1236 patients with preoperative estimated glomerular filtration rate (GFR) of more than 60 ml/ min/1.73 m2 undergoing first isolated OPCAB surgery, in order to evaluate the impacts of mild preoperative renal insufficiency compared with normal preoperative renal function on in-hospital and long-term outcomes in a single-centre, retrospective propensity score matching study
This study focused on patients with mild preoperative renal insufficiency and patients with normal preoperative renal function
Summary
Mild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery. There is less study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and follow-up outcomes after isolated OPCAB surgery. In a majority of previous studies, serum creatinine was usually employed as an indicator for the evaluation of preoperative renal function. Serum creatinine was gradually recognized to be insufficient to accurately indicate the renal function, because it is affected by some factors such as age, gender, and muscle mass [11, 12]. GFR estimated by equations compared with serum creatinine is more objective and accurate, and is a best indicator of renal function so far [13]. Clinical Practice Guidelines for Chronic Kidney Disease developed by the National Kidney Foundation recommend that some equations (Coekeroft-Gault formula, MDRD formula, etc.) may be used to estimate the GFR [12]
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