Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery.
BACKGROUND
Estimation of an individual patient's risk for postoperative dialysis can support informed clinical decision making and patient counseling.


RESULTS
To develop a simple bedside risk algorithm for estimating patients' probability for dialysis after cardiac surgery, we evaluated data of 449,524 patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery and enrolled in >600 hospitals participating in the Society of Thoracic Surgeons National Database (2002-2004). Logistic regression was used to identify major predictors of postoperative dialysis. Model coefficients were then converted into an additive risk score and internally validated. The model also was validated in a second sample of 86,009 patients undergoing cardiac surgery from January to June 2005. Postoperative dialysis was needed in 6451 patients after cardiac surgery (1.4%), ranging from 1.1% for isolated CABG procedures to 5.1% for CABG plus mitral valve surgery. Multivariable analysis identified preoperative serum creatinine, age, race, type of surgery (CABG plus valve or valve only versus CABG only), diabetes, shock, New York Heart Association class, lung disease, recent myocardial infarction, and prior cardiovascular surgery to be associated with need for postoperative dialysis (c statistic=0.83). The risk score accurately differentiated patients' need for postoperative dialysis across a broad risk spectrum and performed well in patients undergoing isolated CABG, off-pump CABG, isolated aortic valve surgery, aortic valve surgery plus CABG, isolated mitral valve surgery, and mitral valve surgery plus CABG (c statistic=0.83, 0.85, 0.81, 0.75, 0.80, and 0.75, respectively).


CONCLUSIONS
Our study identifies the major patient risk factors for postoperative dialysis after cardiac surgery. These risk factors have been converted into a simple, accurate bedside risk tool. This tool should facilitate improved clinician-patient discussions about risks of postoperative dialysis.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Durham, NC 27715, USA. mehta007@dcri.duke.edu
Grab
Joshua D
JD
O'Brien
Sean M
SM
Bridges
Charles R
CR
Gammie
James S
JS
Haan
Constance K
CK
Ferguson
T Bruce
TB
Peterson
Eric D
ED
D000368:Aged; D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019095:Point-of-Care Systems; D011336:Probability; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome