Outcomes of open heart surgery in patients with end-stage renal disease
| Autor: | Hanna Jung, Jeong-Hoon Lim, Jung Hwa Park, Chan-Duck Kim, Sun-Hee Park, Kyung Hee Lee, Gun-Jik Kim, Jang-Hee Cho, Ji-Young Choi, Hee-Yeon Jung, Yong-Lim Kim |
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| Rok vydání: | 2019 |
| Předmět: |
lcsh:Internal medicine
medicine.medical_specialty lcsh:Specialties of internal medicine medicine.medical_treatment Population 030232 urology & nephrology Renal function 030204 cardiovascular system & hematology End stage renal disease 03 medical and health sciences 0302 clinical medicine lcsh:RC581-951 Diabetes mellitus medicine Renal insufficiency lcsh:RC31-1245 education Dialysis education.field_of_study business.industry General Medicine Odds ratio Cardiovascular disease medicine.disease Surgery Thoracic surgery Cardiothoracic surgery Relative risk Original Article business |
| Zdroj: | Kidney Research and Clinical Practice Kidney Research and Clinical Practice, Vol 38, Iss 3, Pp 399-406 (2019) |
| ISSN: | 2211-9140 |
| Popis: | Background : Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes. Methods : We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes. Results : The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group. Conclusion : The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks. |
| Databáze: | OpenAIRE |
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