P121. Effect of Renal Recovery on Long-Term Survival After Aortic Arch 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:
Acute kidney injury (AKI) after aortic arch surgery remains common, causing significant increases in other morbidity and mortality and length of hospital stay. Despite this, even in severe cases of AKI requiring dialysis, some patients will have renal recovery. However, approximately how many patients will have renal recovery, contributing factors to whether patients will have renal recovery, and subsequent impact on long-term mortality are unknown. We sought to further investigate patients who suffer AKI requiring hemodialysis after aortic arch surgery who survive their initial hospital stay, and to determine how many patients have renal recovery, any contributing factors, and the impact of renal recovery or lack thereof on long term mortality.
Methods:
A single center retrospective aortic database was reviewed for all aortic arch procedures from 2011-2023, totally 944 aortic procedures. Patients were filtered for whether they developed acute renal failure post-operatively requiring hemodialysis. Patients that suffered in-hospital mortality were not included in subsequent analysis.
Among surviving patients, they were split into two cohorts: no renal recovery (NR) or renal recovery (RR). Between groups analysis was performed for pre-operative, operative, and post-operative variables, including long term mortality. Additionally, an adjusted Cox proportional hazard model for post-discharge mortality was performed between the two groups.
Results:
In total, 49 patients were identified who had renal failure requiring hemodialysis after aortic arch surgery. Of these patients, 24 (49.0%) suffered in-hospital mortality. Of the remaining 25 patients, 20 (80.0%) patients had subsequent renal recovery. 11 (55.0%) had renal recovery prior to discharge, with the remaining 9 having renal recovery within 3 months of discharge.
Analysis between the NR and RR cohorts of pre-operative, operative and in-hospital postoperative variables demonstrated no significant differences, apart from notably a lower pre-operative creatinine in the NR cohort (p=0.014), although the sample size was small. Notably, after discharge all patients in the NR recovery cohort died within one year (median 177, IQR 146-225), with only one death in the RR cohort (p<0.001).
Conclusions:
In-hospital mortality is common among patients who require renal replacement therapy after aortic arch surgery. If able to survive their post-operative course, most patients will have recovery of their kidney function. However, patients that do not recover kidney function have an absolute risk of mortality within the first year. These findings may help to guide patients who suffer severe acute kidney failure on their overall prognosis after initial surgical recovery.
Authors
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (1), William Riley Keeler (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Acute kidney injury (AKI) after aortic arch surgery remains common, causing significant increases in other morbidity and mortality and length of hospital stay. Despite this, even in severe cases of AKI requiring dialysis, some patients will have renal recovery. However, approximately how many patients will have renal recovery, contributing factors to whether patients will have renal recovery, and subsequent impact on long-term mortality are unknown. We sought to further investigate patients who suffer AKI requiring hemodialysis after aortic arch surgery who survive their initial hospital stay, and to determine how many patients have renal recovery, any contributing factors, and the impact of renal recovery or lack thereof on long term mortality.
Methods:
A single center retrospective aortic database was reviewed for all aortic arch procedures from 2011-2023, totally 944 aortic procedures. Patients were filtered for whether they developed acute renal failure post-operatively requiring hemodialysis. Patients that suffered in-hospital mortality were not included in subsequent analysis.
Among surviving patients, they were split into two cohorts: no renal recovery (NR) or renal recovery (RR). Between groups analysis was performed for pre-operative, operative, and post-operative variables, including long term mortality. Additionally, an adjusted Cox proportional hazard model for post-discharge mortality was performed between the two groups.
Results:
In total, 49 patients were identified who had renal failure requiring hemodialysis after aortic arch surgery. Of these patients, 24 (49.0%) suffered in-hospital mortality. Of the remaining 25 patients, 20 (80.0%) patients had subsequent renal recovery. 11 (55.0%) had renal recovery prior to discharge, with the remaining 9 having renal recovery within 3 months of discharge.
Analysis between the NR and RR cohorts of pre-operative, operative and in-hospital postoperative variables demonstrated no significant differences, apart from notably a lower pre-operative creatinine in the NR cohort (p=0.014), although the sample size was small. Notably, after discharge all patients in the NR recovery cohort died within one year (median 177, IQR 146-225), with only one death in the RR cohort (p<0.001).
Conclusions:
In-hospital mortality is common among patients who require renal replacement therapy after aortic arch surgery. If able to survive their post-operative course, most patients will have recovery of their kidney function. However, patients that do not recover kidney function have an absolute risk of mortality within the first year. These findings may help to guide patients who suffer severe acute kidney failure on their overall prognosis after initial surgical recovery.
Authors
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (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.