Complication Of Cardiac Surgery Research Articles

Atrial Fibrillation after Coronary Bypass Surgery? Is Epicardial Fat a Risk Factor?

Postoperative atrial fibrillation (POAF) is one of the most common complication of cardiac surgery. Epicardial fat tissue may play a role in the development of atrial fibrillation (AF). The aim of this study was to evaluate relationship between epicardial fat volume (EFV) and the appearance of new-onset AF in patients undergoing isolated coronary artery bypass graft (CABG) with normal echocardiographic functions. Between January 2017 and June 2020, 281 coronary artery disease patients undergone isolated CABG surgery with normal echocardiographic functions were included in the study. Patient characteristics, medical history, and perioperative variables were retrospectively collected. Patients with AF predisposition factors were excluded. Sixty-seven patients (23.8%) developed postoperatively AF during hospital stay. In univariate analysis, patients with postoperative AF were older compared with sinus rhythm patients (60.78 ± 9.03 vs. 65.46 ± 9.22, p = 0.001). There are no statistically significant differences between groups and EFV compared (107.78 ± 41.04 vs. 106.66 ± 34.98 p = 0.84). Large left atrial diameter, female patient, cardiopulmonary bypass and longer cross-clamp time showed correlation between POAF without statistical significance. Aging is the only associated factor with AF in this study. There was no EFV difference between POAF and non-AF groups in patients undergoing isolated CABG with normal echocardiographic functions.

Long-Term Preoperative Atorvastatin or Rosuvastatin Use in Adult Patients before CABG Does Not Increase Incidence of Postoperative Acute Kidney Injury: A Propensity Score-Matched Analysis.

Background: Acute kidney injury (AKI) is among the expected complications of cardiac surgery. Statins with pleiotropic anti-inflammatory and antioxidant effects may be effective in the prevention of AKI. However, the results of studies on the efficacy and safety of statins are varied and require further study. Methods: We conducted a retrospective cohort study to evaluate long-term preoperative intake of atorvastatin and rosuvastatin on the incidence of AKI, based on the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria in the early postoperative period after coronary artery bypass graft surgery (CABG). We performed propensity score matching to compare the findings in our study groups. The incidence of AKI was assessed on day 2 and day 4 after the surgery. Results: The analysis included 958 patients after CABG. After 1:1 individual matching, based on propensity score, the incidence of AKI was comparable both on day 2 after the surgery (7.4%) between the atorvastatin group and rosuvastatin group (6.5%) (OR: 1.182; 95%Cl 0.411–3.397; p = 0.794), and on postoperative day 4 between the atorvastatin group (3.7%) and the rosuvastatin group (4.6%) (OR: 0.723, 95%Cl 0.187–2.792; p = 0.739). Additionally, there were no statistically significant differences in terms of incidence of AKI after 1:1 individual matching, based on propensity score, between the rosuvastatin group and the control group both on postoperative day 2 (OR: 0.692; 95%Cl 0.252–1.899; p = 0.611) and day 4 (OR: 1.245; 95%Cl 0.525–2.953; p = 0.619); as well as between the atorvastatin group and the control group both on postoperative day 2 (OR: 0.549; 95%Cl 0.208–1.453; p = 0.240) and day 4 (OR: 0.580; 95%Cl 0.135–2.501; p = 0.497). Conclusion: Long-term statin use before CABG did not increase the incidence of postoperative AKI. Further, we revealed no difference in the incidence of post-CABG AKI between the atorvastatin and rosuvastatin groups.

Shortening of the PR interval in pericarditis after coronary bypass surgery

Background: Pericarditis, following pericardiotomy, is a well-known complication of cardiac surgery. The diagnosis of postpericardiotomy pericarditis (PP) is based on the electrocardiography (ECG) changes the ST segment elevation in combination with a depression of the PR interval. However, in some cases, the ECG changes are difficult to distinguish from the changes associated with ST segment elevation acute coronary syndrome. In such cases, the diagnosis of pericarditis is made by excluding acute coronary syndrome, for which additional expensive diagnostic tests are performed. Aims: the purpose of the study is to identify a pattern in the change in the PR interval, which is detected in patients with acute pericarditis who underwent pericardiotomy during coronary bypass surgery. Methods: The observational study included 47 patients after coronary bypass surgery. We compared ECG of two groups of patients after coronary artery bypass grafting 25 patients who demonstrated the ECG signs of acute pericarditis and 22 patients without those. Results: In most patients with PP after coronary bypass surgery, the characteristic ECG signs of acute pericarditis were accompanied by a transient shortening of the PR interval by 0.04 sec. Conclusion: The absence of such dynamics in patients after coronary artery bypass grafting without the ECG signs of pericarditis may indicate that a transient shortening of the PR interval may be an additional easily available ECG sign of acute PP.

Identification of risk factors for delirium, cognitive decline, and dementia after cardiac surgery (FINDERI—find delirium risk factors): a study protocol of a prospective observational study

BackgroundPostoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing postoperative delirium. Gold standard assessments or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available.MethodsThe FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aim is to validate a delirium risk assessment in context of cardiac surgery. Our secondary aims are to identify specific preoperative and perioperative factors associated with delirium, cognitive decline, and accelerated dementia after cardiac surgery, and to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in patients undergoing cardiac surgery.DiscussionThis prospective, observational study might help to identify patients at high risk for delirium prior to cardiac surgery, and to identify important biological mechanisms by which cardiac surgery is associated with delirium. The predictive value of a delirium screening questionnaire in cardiac surgery might be revealed. Finally, the identification of specific blood biomarkers might help to predict delirium, cognitive decline, and dementia in patients undergoing cardiac surgery.Trial registration: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in the German Clinical Trials Register (DRKS; https://www.drks.de) (DRKS00025095) on April 19th, 2021.

Age, body mass index, and diabetes mellitus are associated with an increased risk of acute kidney injury after coronary surgery: Retrospective cohort study

Background/Aim: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication of cardiac surgery and is associated with increased morbidity and mortality. Identifying risk factors can help clinicians alleviate the risk of developing CSA-AKI and associated complications. Therefore, this study aimed to identify pre-operative patient-related risk factors of CSA-AKI in patients undergoing coronary surgery.
 Methods: The current study was a single-center retrospective cohort study of adult patients undergoing coronary surgery with cardiopulmonary bypass (CPB) over an 8-month period. AKI was scored according to The Kidney Disease Improving Global Outcomes (KDIGO) scoring system. Patients’ age, gender, body mass index (BMI), comorbidities, KDIGO staging in AKI patients, and 30-day mortality rates were recorded. These variables were compared between AKI(−) and AKI (+) groups. Univariate binary regression analysis was performed between the variables that had statistically significant differences and AKI.
 Results: A total of 248 coronary surgery patients were analyzed. The overall incidence of CSA-AKI was 16.5%. Age, BMI, and the proportion of diabetic patients were significantly higher in the AKI (+) group (P = 0.04, P < 0.001, and P = 0.022, respectively). The proportion of gender, chronic obstructive pulmonary disease (COPD), hypertension (HT), baseline creatinine levels, aortic cross-clamping, cardiopulmonary bypass (CPB), total operation duration, and 30-day mortality were similar between the groups. Univariate analysis demonstrated that CSA-AKI was significantly associated with age ³ 65 years (odds ratio [OR] = 2.506; confidence interval [CI]: 1.265–4.967; P = 0.008), BMI of ³ 25 kg m-2 (OR = 8.994; CI: 1.199–67.980; P = 0.033), and diabetes mellitus (OR = 2.171; CI: 1.103–4.273; P = 0.025).
 Conclusion: The current study revealed that patients with increased age, BMI, and DM had a higher incidence of CSA-AKI. Therefore, even though these patient-related variables are known as non-modifiable parameters, more attention should be paid to preventing CSA-AKI during peri-operative management of these patients.

Hybrid approach for cerebral protection in open-heart surgery: Case series.

Stroke remains one of the most important complications of cardiac surgery and occurs in 2.2% after open-heart procedure. It is associated with significant morbidity and mortality. The use of a cerebral protection system during transcatheter aortic valve implantation may be associated with a lower risk of periprocedural strokes, and mortality at 30 days. The aim of the present study was to assess the safety and feasibility of this device in patients at high risk for stroke during open cardiac surgery. We present six patients with a high risk of perioperative stroke who underwent placement of Sentinel cerebral protection system during various open-heart operations between 2018 and 2021. The system was successfully deployed, and debris was retrieved in all patients. There was no device-related complication or development of ischemic stroke postoperatively. One patient suffered from intracranial hemorrhage due to peri-operative coagulopathy. We demonstrated the feasibility and safety of this hybrid approach with a high debris capture rate. It encourages further study to evaluate the benefits of the Sentinel cerebral protection system in reducing stroke and mortality in selected patients undergoing open-heart surgery.

Rectus Abdominis Musculocutaneous Flap With Supercharging for Reconstruction of Extensive Thoracic Defect Due to Deep Sternal Wound Infection: A Case Report

Deep sternal wound infection is a serious postoperative complication of cardiac surgery and often requires flap reconstruction. Herein, we report a case of deep sternal wound infection with an extensive thoracic defect that was successfully treated using a modified technique. This technique, defined as “supercharging,” anastomoses the deep inferior epigastric artery and vein of pedicled rectus abdominis musculocutaneous flap to the transverse cervical artery and external jugular vein, respectively. The transverse cervical artery is an easily accessible and reliable recipient vessel. Therefore, we recommend that our technique be used, especially in cases of deep sternal wound infection with extensive thoracic defects.

The parasternal technique: alternative technique for temporary right ventricular assist device implantation

Right heart failure is a feared complication in cardiac surgery especially after heart failure surgery. Right ventricular assist device (RVAD) implantation is inevitable in severe forms of right heart failure. Different techniques for RVAD implantation exist. We here present our experience with a novel parasternal cannulation technique that allows early mobilization, high RVAD flow rates and easy RVAD removal.

IGFBP7 as a preoperative predictor of congestive acute kidney injury after cardiac surgery

ObjectiveCongestive acute kidney injury (c-AKI) refers to AKI in the presence of right ventricular failure (RVF) and is a highly morbid complication of cardiac surgery. However, treatment has traditionally been...

Prediction of cerebrovascular complications of coronary artery bypass grafting in patients without significant stenosis of the carotid arteries

Introduction. Аpproximately 20% of all patients referred for coronary bypass surgery (CABG) have hemodynamically insignificant carotid artery stenoses. It is known that a decrease in the elasticity of the walls of the arteries of the brain due to atherosclerosis is a risk factor for cerebrovascular complications in cardiac surgery. The purpose of the work. Construction of prognostic models determining the probability of decompensation of chronic cerebral ischemia (CIG) and the development of early postoperative cognitive dysfunction (POCD) in patients with hemodynamically insignificant carotid artery stenosis in the hospital period of CABG performed under conditions of artificial circulation.Material and methods. 58 patients with < 50% carotid artery stenosis were examined, age – 56.2 [52.0; 63.0] years. Neurological, neuropsychological and laboratory-instrumental examinations were performed 2–3 days before and 8–9 days after the operation. The degree of narrowing of the carotid arteries was determined by color duplex scanning. Regression and ROC analyses were performed.Results. Decompensation of HIGM on day 8–9 of CABG was detected in 51.7%, early POCD – in 63.8% of patients. The prognostic criteria for the decompensation of the CIG and the development of early POCD were: a long history of arterial hypertension, low myocardial contractility, estimated by the preoperative index «left ventricular ejection fraction», a low average value of plasma glucose in the intraoperative period and the development of a systemic inflammatory reaction, estimated on the SOFA scale of «5 or more points» in 1–2 days after CABG.Conclusion. With the help of the obtained prognostic models, it is possible to stratify the probability of decompensation of HIGM and the development of early POCD in order to prescribe preventive treatment in a timely manner.

MO423: Does Renal Dysfunction Improve the Predictive Value of Hatch Score for Postoperative Atrial Fibrillation?

Abstract BACKGROUND AND AIMS Postoperative atrial fibrillation (POAF) is a frequent arrhythmic complication in cardiac surgery. Studies of this potential complication have not been able to elucidate its aetiology nor to identify the predictors of its occurrence. The aim of this study was to evaluate the predictive role of a renal dysfunction for POAF in patients undergoing cardiac surgery interventions. We also aimed to determine the role of renal dysfunction in improving the diagnostic accuracy of hypertension, age, transitory attack/stroke, chronic obstructive pulmonary disease, heart failure (HATCH) score for POAF. METHOD This prospective monocentric observational study included 178 consecutive patients who underwent cardiac surgery interventions in the State University Clinic for Cardiac Surgery of Skopje, Republic of North Macedonia, between September 2017 and September 2018. Patients were divided into two groups, according to the absence or occurrence of POAF. HATCH score was calculated and recorded for each patient. A new R-HATCH score was derived by the addition of renal dysfunction to the existing HATCH score and its predictive value for POAF was tested and compared to HATCH. RESULTS POAF occurred in 90/178 patients (50.56%). The average estimated glomerular filtration rate (eGFR) in the group developing POAF was significantly lower, 78.4 ± 26.9 versus 93.0 ± 29.0 mL/min/1,73m2 (P = 0.0005). Patients with GFR < 60mL/min/1.73m2 had almost a 5 times greater risk of developing POAF. The addition of renal dysfunction to HATCH score improved its predictive accuracy in our study. The area under the receiver operating characteristic curve increased from 0.73 to 0.76 (P < 0.001). CONCLUSION The addition of preoperative renal dysfunction could improve the diagnostic accuracy of HATCH score for POAF.

Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis.

BACKGROUNDVasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] is still debated.AIMTo update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia.METHODSAll published studies from MEDLINE, EMBASE, and Web of Science providing relevant data through January 13, 2021 were identified. A random-effects meta-analysis method was used to pool estimates, and post-cardiac surgery shock was differentiated from vasoplegia.RESULTSTen studies reporting on a pooled population of 15672 patients (none looking at ARBs exclusively) were included in the meta-analysis. All were case-control studies. Use of ACEIs was associated with an increased risk of vasoplegia [pooled adjusted odds ratio (Aor) of 2.06, 95%CI: 1.45-2.93] and increased inotropic/vasopressor support requirement (pooled aOR 1.19, 95%CI: 1.10-1.29). Post-cardiac surgery shock was increased in the presence of left ventricular dysfunction (pooled aOR 2.32, 95%CI: 1.60-3.36; I2 49%) but not increased by the use of beta blockers (pooled aOR 0.78, 95%CI: 0.36-1.69; I2 77%). Two randomized control trials (RCTs), not eligible for the meta-analysis, did not show an association between continuation of RAS blockers and vasoplegia. CONCLUSIONPreoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in RCTs. The absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.

Long-term outcome of patients undergoing re-exploration for bleeding following cardiac surgery: a SWEDEHEART study.

Excessive bleeding leading to re-exploration is a severe complication of cardiac surgical procedures, associated with early postoperative morbidity and mortality. Less is known about the long-term outcome of these patients. We evaluated the impact of re-exploration after cardiac surgery on peri- and postoperative morbidity and mortality, as well long-term mortality, in a well-defined nationwide population. In this retrospective study, 48 060 consecutive patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery from 2006 to 2015 were analysed. Multivariable logistic regression was used to identify factors associated with re-exploration, morbidity and mortality. Cox regression analysis was implemented to explore the association between re-exploration and long-term mortality. The mean follow-up time was 4.6 years (range 0-10 years) with follow-up time set at 31 December 2015. Overall, 2371 patients (4.9%) underwent re-exploration. Factors associated with re-exploration included advanced age, procedures other than isolated CABG and acute surgery. Re-explored patients had an increased risk of unadjusted mortality at 30, 90 and beyond 90 days (all P < 0.001). Significance was maintained after adjustment at 30 days [odds ratio: 3.94, 95% confidence interval (CI): 3.19-4.85, P < 0.001] and 90 days (odds ratio: 3.79, 95% CI: 3.14-4.55, P < 0.001), but not with long-term mortality (hazard ratio: 1.02, 95% CI: 0.91-1.15, P = 0.712). Furthermore, re-exploration was independently associated with other postoperative complications, e.g. prolonged hospital stay, stroke and renal injury. Patients who are re-explored for bleeding within 24 h have almost four-fold higher odds of mortality within 3 months post-procedure. However, the increased risk of death following re-exploration is not maintained in the long term.

Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period.

Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545.

Adoption of a novel biomarker-guided quality improvement treatment bundle for patients with subclinical acute kidney injury after cardiac surgery: a Royal Brompton Hospital-King’s Health Partners Innovation Project

Acute kidney injury (AKI) is a common major complication of cardiac surgery, affecting up to 40% of patients, with associated mortality of up to 50%.1 2 G1 cell cycle arrest biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) have been shown to be predictive of AKI after cardiac surgery.3 Urinary biomarker-guided identification of high-risk patients, alongside implementation of a Kidney Disease: Improving Global Outcomes (KDIGO)-based care bundle, can reduce the incidence of post-cardiac surgery AKI.

POS-173 BODY COMPOSITION MONITORING (BCM) TO CORRELATING WITH PREOPERATIVE, POSTOPERATIVE CARDIAC SURGERY AND ACUTE KIDNEY INJURY

Acute Kidney Injury (AKI) is an infrequent but major well-recognised complication of cardiac surgery. Its incidence ranges from 1- 30 %. Technically assisted assessment of volume status before cardiac surgery may be useful to direct intraoperative fluid administration. Using a three-compartment physiologic tissue model, the body composition monitor (BCM, In Body) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of normal volumes.

Perioperative stroke and survival in coronary artery bypass grafting patients: a SWEDEHEART study.

Perioperative stroke is a severe complication of cardiac surgery. We assessed the incidence of stroke over time, the association between stroke and mortality and identified preoperative factors independently associated with perioperative stroke, in a large nationwide cardiac surgery population. All patients who underwent coronary artery bypass grafting in Sweden 2006-2017 were included in a registry-based observational cohort study based on prospectively collected data. Multivariable logistic and Cox regression models were used to assess associations between perioperative stroke and mortality and to identify factors associated with stroke. The median follow-up was 6 years (range 0-12). There were 441 perioperative strokes in 36 898 patients. The mean incidence was 1.2% and decreased marginally over time [adjusted odds ratio (OR) 0.97 per year (95% confidence interval 0.94-1.00), P = 0.035]. Stroke patients had a higher overall mortality risk during follow-up [adjusted hazard ratio 2.30 (2.00-2.64), P < 0.001], with the highest risk during the first 30 postoperative days [adjusted hazard ratio (7.29 (5.58-9.54), P < 0.001]. The strongest independent preoperative factors associated with stroke were prior cardiac surgery [adjusted OR 2.89 (1.40-5.96)], critical preoperative condition [adjusted OR 2.55 (1.73-3.76)], previous stroke [adjusted OR 1.77 (1.35-2.33)], preoperative angina requiring intravenous nitrates [adjusted OR 1.67 (1.28-2.17)], peripheral vascular disease [OR 1.63 (1.25-2.13)] and advanced age [OR 1.05 (1.03-1.06) per year]. The incidence of perioperative stroke after coronary artery bypass grafting has remained stable. Patients with perioperative stroke had a markedly higher adjusted risk of death early after surgery. The risk declined over time but remained higher during the entire follow-up period.

Local infectious complications in cardiac surgery: etiology and the role of antimicrobial prophylaxis

To investigate the relationship between antimicrobial prophylaxis protocol, prevalence and etiology of local infectious complications after open cardiac surgery. A retrospective cohort observational study was performed between 2010 and 2019 at the Ural Institute of Cardiology. Antimicrobial prophylaxis was performed using the main (cefuroxime 1.5 g IV every 6 hours) and alternative protocols (vancomycin 15 mg/kg IV every 12 hours). The prevalence of local infectious complications throughout the entire follow-up period was 4.5±0.3% [95% CI 4.45-4.54]. There were 42 cases of deep infection (0.9±0.13%). Coagulase-negative staphylococci prevailed (15.9±2.5% of cases, 35 cultures). Resistant flora included coagulase-negative methicillin-resistant staphylococci (13 cultures, 37.1±8.2%) and representatives of Enterobacteriaceae family, producers of extended-spectrum beta-lactamase (8 cultures, 50.0±18.2%). Antimicrobial prophylaxis with vancomycin increases the risk of local infectious complications (OR 1.75, 95% CI 1.20, 2.55, p=0.001). Both protocols of antimicrobial prophylaxis demonstrated comparable efficacy against gram-positive and gram-negative microorganisms. Coagulase-negative staphylococci are the most common cause of local infectious complications in cardiac surgery. Modern antimicrobial prophylaxis regimens are relevant despite resistant flora.

Patient Frailty Can Increase the Risk of Acute Kidney Injury after Cardiac Surgery: Pilot Study

Background: Acute kidney injury (AKI) is a severe common postoperative complication of cardiac surgery (CS). It increases the risk of mortality by up to 80%. Therefore, it is essential to have preoperative risk evaluation tools. Frailty is a marker of deterioration of physiologic systems and may be associated with AKI. Purpose: The study aimed to determine the utility of frailty as a predictor of AKI after CS. Method: We enrolled 91 patients undergoing CS with cardiopulmonary bypass to determine if they had frailty before surgery and were associated with postoperative AKI. The diagnosis of postoperative AKI was based on the serum creatinine criteria of the Acute Kidney Injury Network classification up to 7 days following CS. Results: The incidence of postoperative AKI was 62% in the frail group and 21% in the non-frail group. Frailty was associated with a higher risk of AKI (relative risk [RR] = 3.00, 95% CI 1.56 - 5.77, p = 0.00). In regression models, there were associations between frailty and postoperative AKI. Conclusion: This study demonstrated that frailty could be a predictor for post-CS AKI. Therefore, frailty assessment should become an essential part of the preoperative evaluation to help the anesthesiologist to estimate the surgical risk and develop preoperative and transoperative strategies to preserve the renal function and improve the cardiac surgery outcome.

Patient Frailty Can Increase the Risk of Acute Kidney Injury after Cardiac Surgery: Pilot Study

Background: Acute kidney injury (AKI) is a severe common postoperative complication of cardiac surgery (CS). It increases the risk of mortality by up to 80%. Therefore, it is essential to have preoperative risk evaluation tools. Frailty is a marker of deterioration of physiologic systems and may be associated with AKI. Purpose: The study aimed to determine the utility of frailty as a predictor of AKI after CS. Method: We enrolled 91 patients undergoing CS with cardiopulmonary bypass to determine if they had frailty before surgery and were associated with postoperative AKI. The diagnosis of postoperative AKI was based on the serum creatinine criteria of the Acute Kidney Injury Network classification up to 7 days following CS. Results: The incidence of postoperative AKI was 62% in the frail group and 21% in the non-frail group. Frailty was associated with a higher risk of AKI (relative risk [RR] = 3.00, 95% CI 1.56 - 5.77, p = 0.00). In regression models, there were associations between frailty and postoperative AKI. Conclusion: This study demonstrated that frailty could be a predictor for post-CS AKI. Therefore, frailty assessment should become an essential part of the preoperative evaluation to help the anesthesiologist to estimate the surgical risk and develop preoperative and transoperative strategies to preserve the renal function and improve the cardiac surgery outcome.