title: Association between preoperative diuretic use and in-hospital outcomes after cardiac surgery.
abstract: BACKGROUND
  There is a paucity of evidence on the association between preoperative diuretics use and outcomes following cardiac surgery. We hypothesized that diuretic use prior to cardiac surgery will be associated with adverse in-hospital clinical outcomes.
  
  
  METHODS
  We evaluated patients undergoing cardiac surgery at a single institution between January 1, 2000, and December 31, 2011. Patients were grouped as follows: isolated coronary artery bypass grafting (CABG) (n = 8759), CABG plus valve surgery (n = 1188), and valve surgery only (n = 2646). A fourth group "All cardiac surgery" is comprised of patients from all three groups. Preoperative diuretic use was defined as patient on any diuretic till the day of surgery. Primary outcome was the incidence of major adverse events (MAEs) defined as the composite of mortality, postoperative renal dysfunction, myocardial infarction, stroke, and new-onset atrial fibrillation (AF). Logistic regression analysis and propensity score matching were performed.
  
  
  RESULTS
  We included 12,593 patients [3546 on diuretic (28%)]. After logistic regression analyses, preoperative diuretic use was associated with an increased risk of the following: (1) MAE among all groups except the concomitant CABG and valve surgery group, (2) AF in "All cardiac surgery" and isolated CABG groups, (3) postoperative renal dysfunction in all groups. After propensity score matching (n = 3050 in each group), preoperative diuretic use was significantly associated with MAE (48% vs. 43%; P < 0.0001), postoperative renal dysfunction (19% vs. 14%; P < 0.0001), and AF (34% vs. 32%; P = 0.03) in the "All cardiac surgery" group.
  
  
  CONCLUSIONS
  Preoperative diuretics use is associated with an increased incidence of MAEs after cardiac surgery.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Salman J
authors.initials: SJ
authors.lastname: Bandeali
authors.forename: Waleed T
authors.initials: WT
authors.lastname: Kayani
authors.forename: Vei-Vei
authors.initials: VV
authors.lastname: Lee
authors.forename: MacArthur
authors.initials: M
authors.lastname: Elayda
authors.forename: Mahboob
authors.initials: M
authors.lastname: Alam
authors.forename: Henry D
authors.initials: HD
authors.lastname: Huang
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.forename: John
authors.initials: J
authors.lastname: Farmer
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D004232:Diuretics
keywords: Cardiac surgery; Coronary artery bypass grafting; Diuretics; Outcomes; Valve replacement