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Acute renal failure after isolated CABG surgery: six years of experience
G Landoni1, T Bove, M Crivellari
1Department of Cardiothoracic Anesthesia and Intensive Care, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. landoni.giovanni@hsr.it
Insights
Acute Renal Failure (ARF) after coronary artery bypass graft surgery is predicted by preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction, and age. ARF significantly increases ICU and hospital stays.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Investigating the incidence and predictors of Acute Renal Failure (ARF) post-coronary artery bypass graft (CABG) surgery.
- Examining the impact of ARF on patient outcomes in a Cardiosurgical Intensive Care Unit (ICU).
Purpose of the Study:
- To determine the incidence of ARF following CABG surgery.
- To identify independent predictors of ARF in this patient population.
- To assess the effect of ARF on ICU and hospital length of stay.
Main Methods:
- Prospective observational study of 3,013 consecutive patients undergoing CABG surgery.
- Collected baseline, intraoperative, and postoperative variables, including demographics, comorbidities, surgical details, and complications.
- Statistical analysis to identify independent predictors of ARF and assess outcome associations.
Main Results:
- Preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction, and advanced age were independently associated with ARF.
- Patients developing ARF had significantly longer ICU stays (median 5.5 vs. 1 day) and hospital stays (median 10 vs. 5 days).
Conclusions:
- Key predictors of ARF after CABG include preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction, and age.
- Development of ARF significantly prolongs both ICU and overall hospital length of stay.
Background:
A prospective observational study was carried out in a Cardiosurgical Intensive Care Unit (ICU) in order to evaluate the incidence of Acute Renal Failure (ARF) after coronary artery bypass graft surgery and identify its predictors. The effects of ARF on outcome were also investigated.
Methods:
The study enrolled 3,013 consecutive patients undergoing coronary artery bypass graft surgery. Baseline variables including age, sex, preoperative renal failure, left-ventricular dysfunction, emergency surgery, neurological adverse events, patient history of chronic obstructive pulmonary disease and diabetes mellitus were collected. Intraoperative variables were: type of surgery (on- or off-pump), intra-aortic balloon pump placement, and cardiopulmonary bypass duration. The measured postoperative variables were: low cardiac output syndrome, hemorrhage, transfusion of blood products, and surgical revision.
Results:
Preoperative renal dysfunction (creatinine >1.4 mg/dL), blood transfusion, low-output syndrome, emergency surgery, low ejection fraction and age were independently associated with ARF. The median (interquartile range) ICU stay was 5.5 (range 4-11.5) days in patients who did and 1 (range 1-2) day in those who did not develop ARF (P<0.001). The median (interquartile range) hospital length of stay was 10 (range 8-21) days in patients who did and 5 (range 4-7) days in those who did not develop ARF (P<0.001).
Conclusion:
Preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction and age were independently associated with ARF. Length of ICU and hospital stay were reduced in patients not developing ARF.
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