title: Incidence of postoperative acute kidney injury in patients with chronic kidney disease undergoing minimally invasive valve surgery.
abstract: BACKGROUND
  We hypothesize that minimally invasive valve surgery in patients with chronic kidney disease (CKD) is superior to a conventional median sternotomy.
  
  
  METHODS
  We retrospectively analyzed 1945 consecutive patients who underwent isolated valve surgery. Included were patients with CKD stages 2 to 5. In-hospital mortality, composite complication rates, and intensive care unit and total hospital lengths of stay of those who underwent a minimally invasive approach were compared with those who underwent a standard median sternotomy. Resource use was approximated based on intensive care unit and total hospital lengths of stay.
  
  
  RESULTS
  There were 688 patients identified; 510 (74%) underwent minimally invasive surgery, and 178 (26%) underwent a median sternotomy. There was no significant difference in mortality. Minimally invasive surgery was associated with fewer composite complications (33.1% vs 49.4%; odds ratio, 0.5; P ≤ .001), shorter intensive care unit (48 [interquartile range {IQR}, 33-74] hours vs 71 [IQR, 42-96] hours; P < .01), and hospital (8 [IQR, 6-9] days vs 10 [IQR, 8-15] days; P < .001) lengths of stay, and a lower incidence of acute kidney injury (8% vs 14.7%; odds ratio, 0.5; P = .01), compared with median sternotomy. In a multivariable analysis, minimally invasive surgery was associated with a 60% reduction in the risk of development of postoperative acute kidney injury.
  
  
  CONCLUSIONS
  In patients with CKD undergoing isolated valve surgery, minimally invasive valve surgery is associated with reduced postoperative complications and lower resource use.
authors: the Department of Internal Medicine, Miami Beach, Fla.
authors: Gerson D
authors: GD
authors: Valdez
authors: Christos G
authors: CG
authors: Mihos
authors: Orlando
authors: O
authors: Santana
authors: Todd B
authors: TB
authors: Heimowitz
authors: Robert
authors: R
authors: Goldszer
authors: Gervasio A
authors: GA
authors: Lamas
authors: Joseph
authors: J
authors: Lamelas
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005431:Florida / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D015999:Multivariate Analysis; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: 35.3.7; 41.3; AKI; CKD; IQR; RIFLE; Risk, Injury, Failure, Loss, End-stage renal disease; acute kidney injury; chronic kidney disease; eGFR; estimated glomerular filtration rate; interquartile range