P026. Acute Kidney Injury of Any Degree in Total Arch Surgery Contributes to Stepwise Increase in Post-Operative Morbidity and Mortality
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
While it is well-established that severe acute kidney injury (AKI) after aortic arch surgery increases morbidity and mortality, the impact of less severe kidney injury conflicts in the literature. Current STS criteria encompasses only the most severe kidney injury, which as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, only encapsulates Stage 3 AKI. Given the prolonged operative time required for total arch replacement (TAR), we believe that even mild kidney injury could be reflective of greater whole-body injury. We sought to investigate the spectrum of kidney injury in total arch replacement and its impact on post-operative morbidity and mortality.
Methods:
We performed a single-center retrospective review of patients who underwent TAR from 2014-2023. Patients were stratified into three cohorts based on KDIGO criteria: no AKI, KDIGO stage 1 and stage 2/3 to optimize study power. Multivariable logistic regression was performed for pre-operative and operative variables for development of AKI, with subsequent additional analysis for significant variables and correlation with in-hospital major adverse cardiovascular events (MACE, defined as stroke, myocardial infarction, and death). Adjusted Cox regression analysis was performed for post-operative mortality, as stratified by degree of kidney injury.
Results:
Any degree of AKI occurred in 95/235 (40.4%) of the cohort, with twenty-seven stage 2/3 patients requiring renal replacement therapy. There was no significant difference between the three cohorts regarding pre-operative variables. Regarding operative data, procedural urgency (p < 0.001), and cardiopulmonary bypass time (p<0.001) were significantly associated with AKI development. Any degree of AKI, with progression depending on severity, was associated with increased postoperative ICU morbidity, mortality, and MACE. Adjusted Cox regression analysis confirmed that AKI based on KDIGO criteria (1, 2/3) was an independent predictor of 30-day mortality (p<0.001, Hazard ratio = 2.63, 11.07).
Conclusions:
Acute kidney injury occurs across a spectrum in total arch surgery, with even mild kidney injury carrying the potential to increase post-operative morbidity and mortality. To further investigate outcomes of mild AKI, quality guidelines should be adjusted to capture kidney injury across its full spectrum.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Bo Chang Wu (1), Michal Schafer (1), William Riley Keeler (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
While it is well-established that severe acute kidney injury (AKI) after aortic arch surgery increases morbidity and mortality, the impact of less severe kidney injury conflicts in the literature. Current STS criteria encompasses only the most severe kidney injury, which as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, only encapsulates Stage 3 AKI. Given the prolonged operative time required for total arch replacement (TAR), we believe that even mild kidney injury could be reflective of greater whole-body injury. We sought to investigate the spectrum of kidney injury in total arch replacement and its impact on post-operative morbidity and mortality.
Methods:
We performed a single-center retrospective review of patients who underwent TAR from 2014-2023. Patients were stratified into three cohorts based on KDIGO criteria: no AKI, KDIGO stage 1 and stage 2/3 to optimize study power. Multivariable logistic regression was performed for pre-operative and operative variables for development of AKI, with subsequent additional analysis for significant variables and correlation with in-hospital major adverse cardiovascular events (MACE, defined as stroke, myocardial infarction, and death). Adjusted Cox regression analysis was performed for post-operative mortality, as stratified by degree of kidney injury.
Results:
Any degree of AKI occurred in 95/235 (40.4%) of the cohort, with twenty-seven stage 2/3 patients requiring renal replacement therapy. There was no significant difference between the three cohorts regarding pre-operative variables. Regarding operative data, procedural urgency (p < 0.001), and cardiopulmonary bypass time (p<0.001) were significantly associated with AKI development. Any degree of AKI, with progression depending on severity, was associated with increased postoperative ICU morbidity, mortality, and MACE. Adjusted Cox regression analysis confirmed that AKI based on KDIGO criteria (1, 2/3) was an independent predictor of 30-day mortality (p<0.001, Hazard ratio = 2.63, 11.07).
Conclusions:
Acute kidney injury occurs across a spectrum in total arch surgery, with even mild kidney injury carrying the potential to increase post-operative morbidity and mortality. To further investigate outcomes of mild AKI, quality guidelines should be adjusted to capture kidney injury across its full spectrum.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Bo Chang Wu (1), Michal Schafer (1), William Riley Keeler (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.