Acute Kidney Injury After Cardiac Surgery: Does the Time Interval From Contrast Administration to Surgery Matter

Journal of Cardiothoracic and Vascular Anesthesia, 04/25/2012

McIlroy DR et al. – In an appropriately selected population, cardiac surgery can be performed within 1day of cardiovascular catheterization and contrast administration without an increase in the incidence of postoperative AKI. Recommendations to delay cardiac surgery for a specified period after contrast administration to reduce the risk of postoperative acute kidney injury (AKI) are premature. Additional evidence is required before making recommendations on optimal surgical timing after contrast exposure.

Methods

  • Six hundred forty-four adult patients undergoing nonemergent cardiac surgery.

Results

  • AKI was defined as an increase in serum creatinine by ≥0.3mg/dL or ≥50% above baseline within the first 2 postoperative days or the commencement of renal replacement therapy within the same period.
  • Using a contrast-to-surgery time interval >7days as the baseline, multivariable logistic regression analysis determined the association between a contrast-to-surgery time interval ≤1day or 2 to 7days and postoperative AKI adjusting for potential confounding variables.
  • The incidence of AKI within the study cohort was 21.9%.
  • After adjusting for other covariates, there was no association between the contrast-to-surgery time and AKI (odds ratio [OR] ≤1day=0.93; 95% confidence interval [CI], 0.52-1.66; p=0.81; OR=2-7days=1.28; 95% CI, 0.78-2.11; p=0.34).

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