Journal article
Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications
The Journal of thoracic and cardiovascular surgery, Vol.163(4), pp.1378-1387
04/01/2022
DOI: 10.1016/j.jtcvs.2020.03.174
PMCID: PMC7762739
PMID: 32739165
Abstract
Objectives: Baseline kidney function is a key predictor of postoperative morbidity and mortality. Whether an increased creatinine at the time of surgery, compared with the lowest creatinine in the 3 months before surgery, is associated with poor outcomes has not been evaluated. We examined whether creatinine elevations from "baseline" were associated with adverse postoperative outcomes.
Methods: A total of 1486 patients who underwent cardiac surgery at the University of Colorado Hospital between January 2011 and May 2016 met inclusion criteria. "Change in creatinine from baseline" was defined as the difference between the immediate presurgical creatinine value and the lowest creatinine value within 3 months preceding surgery. Outcomes evaluated were in-hospital mortality, postoperative infection, postoperative stroke, development of stage 3 acute kidney injury, intensive care unit length of stay, and hospital length of stay. Outcomes were adjusted using a balancing score to account for differences in patient characteristics.
Results: There were significant increases in the odds of postoperative infection (odds ratio, 1.17; confidence interval, 1.02-1.34; per 0.1 mg/dL increase in creatinine), stage 3 acute kidney injury (odds ratio, 1.44; confidence interval; 1.18- 1.75), intensive care unit length of stay (odds ratio, 1.13; confidence interval, 1.01-1.26), and hospital length of stay (odds ratio, 1.09; confidence interval, 1.05-1.13). There was a significant increase in mortality in the unadjusted analysis, although not after adjustment using a balancing score. There was no association with postoperative stroke.
Conclusions: Elevations in creatinine at the time of surgery above the "baseline" level are associated with increased postoperative morbidity. Baseline creatinine should be established before surgery, and small changes in creatinine should trigger heightened vigilance in the postoperative period.
Details
- Title: Subtitle
- Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications
- Creators
- Benjamin R. Griffin - University of Colorado Anschutz Medical CampusMichael Bronsert - Outcomes Research ConsortiumT. Brett Reece - University of Colorado DenverJay D. Pal - University of Colorado DenverJoseph C. Cleveland - University of Colorado DenverDavid A. Fullerton - University of Colorado DenverSarah Faubel - University of Colorado Anschutz Medical CampusMuhammad Aftab - University of Colorado Anschutz Medical Campus
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.163(4), pp.1378-1387
- Publisher
- Elsevier
- DOI
- 10.1016/j.jtcvs.2020.03.174
- PMID
- 32739165
- PMCID
- PMC7762739
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Number of pages
- 10
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100014450, name: Anschutz Medical Campus, University of Colorado
- Language
- English
- Date published
- 04/01/2022
- Academic Unit
- Nephrology; Internal Medicine
- Record Identifier
- 9984359951602771
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