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Background: Several studies have been reporting circadian variation in postoperative morbidity and mortality. We investigated whether the outcomes after off-pump coronary artery bypass (OPCAB) surgery are influenced by the operation start time.Methods: We retrospectively evaluated 1690 patients who received elective OPCAB surgery from January 2006 to December 2016. The patients were divided into two groups according to the operation start time (morning or afternoon). The primary outcome was the occurrence of a major adverse cardiac event (MACE) within 30 days after surgery and death within 1 year after surgery. Propensity matching analysis and multivariable analyses were performed to evaluate the relationship between the operation start time and postoperative outcomes.Results: There were no significant differences in the overall 1-year mortality rate (2.2% vs 2.9%; P = .568 in the entire cohort and 1.5% vs 2.7%; P = .259 in the propensity-matched cohort) and 30-day MACE rate (8.9% vs 10.4%; P = .378 in the entire cohort and 9.4% vs 10.0%; P = .827 in the propensity-matched cohort) between the morning and afternoon surgery group. Multivariable regression analyses also did not show any significant relationship between the operation start time and postoperative outcomes.Conclusions: In elective OPCAB surgery, the operative time was not associated with an increased risk of postoperative mortality and complications. [ABSTRACT FROM AUTHOR]

Background: Although serum creatinine concentration has been traditionally used as an index of renal function in clinical practice, it is considered relatively inaccurate, especially in patients with mild renal dysfunction. This study investigated the usefulness of preoperative estimated glomerular filtration rate (eGFR) in predicting complications after cardiovascular surgery in patients with normal serum creatinine concentrations. Methods: This study included 2208 adults undergoing elective cardiovascular surgery. Preoperative eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equations. The relationships between preoperative eGFR and 90 day postoperative composite major complications were analyzed, including 90 day all-cause mortality, major adverse cardiac and cerebrovascular events, severe acute kidney injury, respiratory and gastrointestinal complications, wound infection, sepsis, and multi-organ failure. Results: Of the 2208 included patients, 185 (8.4%) had preoperative eGFR < 60 mL/min/1.73 m2 and 328 (14.9%) experienced postoperative major complications. Multivariable logistic regression analyses showed that preoperatively decreased eGFR was independently associated with an increased risk of composite 90 day major postoperative complications (adjusted odds ratio: 1.232; 95% confidence interval [CI]: 1.148–1.322; P < 0.001). eGFR was a better discriminator of composite 90 day major postoperative complications than serum creatinine, with estimated c-statistics of 0.724 (95% CI: 0.694–0.754) for eGFR and 0.712 (95% CI: 0.680–0.744) for serum creatinine (P = 0.008). Conclusions: Decreased eGFR was significantly associated with an increased risk of major complications after cardiovascular surgery in patients with preoperatively normal serum creatinine concentrations. [ABSTRACT FROM AUTHOR]