P095. Decreased Long-Term Survival After Severe Acute Kidney Injury in Hemiarch Surgery
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:
Although hemiarch surgery is associated with reduced cardiopulmonary bypass (CPB), aortic cross clamp, and circulatory arrest times relative to total arch surgery, acute kidney injury remains a significant complication that contributes to in-hospital morbidity and mortality. Prior studies have investigated long-term survival after acute kidney injury in type A aortic dissection, however, these studies have included different methods of arch management. We evaluated hemiarch patients for pre-operative and operative characteristics that place patients at risk for developing acute kidney injury, any corresponding in-hospital outcomes, and subsequent long-term mortality after acute kidney injury.
Methods:
We performed a retrospective review of 616 patients who underwent hemiarch replacement at our institution from 2011-2023. AKI was categorized based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria which accounts for change from preoperative renal function. Pre-operative and operative characteristics, as well as post-operative outcomes were analyzed for relationship to AKI development. A multivariate logistic regression model was used to identify risk factors associated with AKI. Adjusted Cox proportional hazard regression was used to determine long-term mortality after acute kidney injury, using time to last documented follow-up with any provider or date of mortality to determine duration.
Results:
Any degree of AKI occurred in 198/616 (32.1%) of cases. On univariate analysis, multiple pre-operative variables were associated with acute kidney injury, including age (p=0.020), BMI (0.018), baseline CKD (0.011), and procedural urgency (p<0.001). Regarding operative variables, prolonged CPB (p<0.001), aortic cross-clamp (p=0.015), circulatory arrest (p<0.001) were associated with worsening AKI. Lower nadir bladder temperature was associated with worsening AKI (p<0.001), however, temperature ranges were in the range for moderate hypothermia. Rates of intraoperative transfusion of packed red blood cells, fresh frozen plasma, platelets, and post-operative open chest were higher for more severe AKI (p<0.001). Length of stay, ICU length of stay, coagulopathy, delirium, prolonged ventilation, infection, need for adjunctive mechanical circulatory support, and mortality were all significantly higher in Stage 3 kidney injury (p<0.001).
Multivariate logistic regression of significant pre-operative and operative variables demonstrated a significant relationship with development of any AKI (AUC 0.738, p<0.001). Significant predictor variables included BMI (p=0.007) and procedural urgency (0.004).
All cohorts had excellent post-discharge follow-up, with median follow-up for all groups exceeding 1000 days. Post-discharge mortality was significantly higher in the stage 3 KDIGO group (p=0.048), with adjusted Cox proportional hazard demonstrating a significant increase in mortality for patients with stage 3 AKI (p<0.001).
Conclusions:
AKI after hemiarch surgery of any degree is common, with more severe AKI increasing risk for short-term morbidity and mortality. Hemiarch patients with severe stage 3 AKI face not only the greatest risk of in-hospital mortality, but significantly increased risk of post-discharge mortality.
Authors
Adam Carroll (1), Michal Schafer (1), William Riley Keeler (1), Jintong Liu (1), Nicolas Chanes (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Although hemiarch surgery is associated with reduced cardiopulmonary bypass (CPB), aortic cross clamp, and circulatory arrest times relative to total arch surgery, acute kidney injury remains a significant complication that contributes to in-hospital morbidity and mortality. Prior studies have investigated long-term survival after acute kidney injury in type A aortic dissection, however, these studies have included different methods of arch management. We evaluated hemiarch patients for pre-operative and operative characteristics that place patients at risk for developing acute kidney injury, any corresponding in-hospital outcomes, and subsequent long-term mortality after acute kidney injury.
Methods:
We performed a retrospective review of 616 patients who underwent hemiarch replacement at our institution from 2011-2023. AKI was categorized based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria which accounts for change from preoperative renal function. Pre-operative and operative characteristics, as well as post-operative outcomes were analyzed for relationship to AKI development. A multivariate logistic regression model was used to identify risk factors associated with AKI. Adjusted Cox proportional hazard regression was used to determine long-term mortality after acute kidney injury, using time to last documented follow-up with any provider or date of mortality to determine duration.
Results:
Any degree of AKI occurred in 198/616 (32.1%) of cases. On univariate analysis, multiple pre-operative variables were associated with acute kidney injury, including age (p=0.020), BMI (0.018), baseline CKD (0.011), and procedural urgency (p<0.001). Regarding operative variables, prolonged CPB (p<0.001), aortic cross-clamp (p=0.015), circulatory arrest (p<0.001) were associated with worsening AKI. Lower nadir bladder temperature was associated with worsening AKI (p<0.001), however, temperature ranges were in the range for moderate hypothermia. Rates of intraoperative transfusion of packed red blood cells, fresh frozen plasma, platelets, and post-operative open chest were higher for more severe AKI (p<0.001). Length of stay, ICU length of stay, coagulopathy, delirium, prolonged ventilation, infection, need for adjunctive mechanical circulatory support, and mortality were all significantly higher in Stage 3 kidney injury (p<0.001).
Multivariate logistic regression of significant pre-operative and operative variables demonstrated a significant relationship with development of any AKI (AUC 0.738, p<0.001). Significant predictor variables included BMI (p=0.007) and procedural urgency (0.004).
All cohorts had excellent post-discharge follow-up, with median follow-up for all groups exceeding 1000 days. Post-discharge mortality was significantly higher in the stage 3 KDIGO group (p=0.048), with adjusted Cox proportional hazard demonstrating a significant increase in mortality for patients with stage 3 AKI (p<0.001).
Conclusions:
AKI after hemiarch surgery of any degree is common, with more severe AKI increasing risk for short-term morbidity and mortality. Hemiarch patients with severe stage 3 AKI face not only the greatest risk of in-hospital mortality, but significantly increased risk of post-discharge mortality.
Authors
Adam Carroll (1), Michal Schafer (1), William Riley Keeler (1), Jintong Liu (1), Nicolas Chanes (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Presentation Duration
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