• Robert S Kramer, Reed D Quinn, Robert C Groom, John H Braxton, David J Malenka, Mirle A Kellett, Jeremiah R Brown, and Northern New England Cardiovascular Disease Study Group.
• Division of Cardiothoracic Surgery, Maine Medical Center R8, 22 Bramhall St, Portland, ME 04102, USA. kramer@mmc.org
• Ann. Thorac. Surg. 2010 Nov 1;90(5):1418-23; discussion 1423-4.

BackgroundAcute kidney injury (AKI) is predictive of increased long-term mortality after cardiac surgery. Patients often undergo surgery after cardiac catheterization during the same admission for reasons of instability and threatening anatomy as well as nonurgent reasons such as patient convenience. We hypothesized that patients undergoing cardiac catheterization and cardiac surgery during the same admission are more likely to develop AKI after cardiac surgery than patients for whom surgery is performed on a later admission.MethodsWe prospectively enrolled 668 nonemergent adult cardiac surgical cases. Patients having heart catheterization were divided into two groups: cardiac catheterization followed by cardiac surgery during the same hospital admission (same admission) or catheterization followed by surgery during a later admission (later admission). The AKI was defined by an increase in serum creatinine from baseline by 50% or greater or 0.3 (mg/dL) or greater. Univariable and multivariable logistic regression and propensity-matched analyses were conducted.ResultsThe incidence of AKI was significantly higher in the patients who had same admission cardiac catheterization and surgery (50.2%) compared with patients who had surgery on a later admission (33.7%, p = 0.009). The adjusted odds ratio for surgery on a later admission was 1.54 (95% confidence interval: 1.11 to 2.13) suggesting a 54% increased risk of AKI. Propensity-matched results were similar with 1.58 (95% confidence interval: 1.13 to 2.22).ConclusionsWhen cardiac catheterization and cardiac surgery occur during the same hospitalization, there is an increased risk for postoperative AKI. After cardiac catheterization, discharge and readmission for nonurgent surgery should be considered as such an approach might reduce the risk of AKI.Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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