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Purpose The effect of hyperglycemia on acute kidney injury (AKI) in patients undergoing cardiac surgery is unclear and may involve as yet unexplored factors. We hypothesized differential effects of intraoperative hyperglycemia on AKI after cardiac surgery depending on baseline inflammatory status, as reflected by the C-reactive protein (CRP) level. Methods This retrospective study included patients who underwent cardiac surgery seen at our hospital from 2008 to 2018. Patients were classified into four groups according to their preoperative CRP level ([greater than or equal to] 1 or 140 or [less than or equal to] 140 mg/dl): low CRP and normoglycemia, low CRP and hyperglycemia, high CRP and normoglycemia, and high CRP and hyperglycemia. The data were analyzed by multivariable logistic regression analysis. Results The data of 3625 patients were analyzed. The logistic regression showed that patients in the high CRP and hyperglycemia group had a significantly higher risk of AKI than patients in the low CRP and normoglycemia group [odds ratio (OR), 1.58; 95% confidence interval (CI) 1.10-2.27], low CRP with hyperglycemia group (OR, 1.69; 95% CI 1.16-2.47) and high CRP with normoglycemia group (OR, 1.50; 95% CI 1.01-2.23). Conclusions Intraoperative hyperglycemia in patients with an elevated preoperative CRP level was significantly related to an increased risk of AKI after cardiac surgery. Individualized perioperative glycemic control may therefore be necessary in these patients., Author(s): Seohee Lee [sup.1], Seungpyo Nam [sup.1], Jinyoung Bae [sup.1], Youn Joung Cho [sup.1], Yunseok Jeon [sup.1], Karam Nam [sup.1] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, Seoul [...]

Background: To maintain adequate oxygenation is of utmost importance in intraoperative care. However, clinical evidence supporting specific oxygen levels in distinct surgical settings is lacking. This study aimed to compare the effects of 30% and 80% oxygen in off-pump coronary artery bypass grafting (OPCAB). Methods: This multicenter trial was conducted in three tertiary hospitals from August 2019 to August 2021. Patients undergoing OPCAB were cluster-randomized to receive either 30% or 80% oxygen intraoperatively, based on the month when the surgery was performed. The primary endpoint was the length of hospital stay. Intraoperative hemodynamic data were also compared. Results: A total of 414 patients were cluster-randomized. Length of hospital stay was not different in the 30% oxygen group compared to the 80% oxygen group (median, 7.0 days vs 7.0 days; the sub-distribution hazard ratio, 0.98; 95% confidence interval [CI] 0.83–1.16; P = 0.808). The incidence of postoperative acute kidney injury was significantly higher in the 30% oxygen group than in the 80% oxygen group (30.7% vs 19.4%; odds ratio, 1.94; 95% CI 1.18–3.17; P = 0.036). Intraoperative time-weighted average mixed venous oxygen saturation was significantly higher in the 80% oxygen group (74% vs 64%; P < 0.001). The 80% oxygen group also had a significantly greater intraoperative time-weighted average cerebral regional oxygen saturation than the 30% oxygen group (56% vs 52%; P = 0.002). Conclusions: In patients undergoing OPCAB, intraoperative administration of 80% oxygen did not decrease the length of hospital stay, compared to 30% oxygen, but may reduce postoperative acute kidney injury. Moreover, compared to 30% oxygen, intraoperative use of 80% oxygen improved oxygen delivery in patients undergoing OPCAB. Trial registration ClinicalTrials.gov (NCT03945565; April 8, 2019). [ABSTRACT FROM AUTHOR]

The objective of the study was to analyze patients who underwent cardiac surgery using the National Health Insurance Service (NHIS) database in Korea to evaluate the following: (1) the current trends in pulmonary artery catheter (PAC) utilization in patients who undergo cardiac surgery, (2) the association between perioperative PAC use and postoperative mortality, and (3) if this association varies with the type of cardiac surgery or by institutional case volume. This nationwide, population-based cohort study included adult patients who underwent coronary artery bypass grafting (CABG), aortic valve surgery, mitral valve surgery, and/or thoracic aorta surgery from January 2011 to December 2020. Patients were categorized based on perioperative PAC usage into PAC and no PAC groups. The primary outcome was 1-year all-cause postoperative mortality after cardiac surgery. To evaluate the association of perioperative PAC use with 1-year all-cause mortality, we performed logistic regression analysis while using propensity score matching (PSM) to adjust for confounders. Subgroup analyses were conducted based on type of surgery and institutional case volume (<100, 100–500, and >500 cases/year). Of the 68,716 patients analyzed, PAC was used in 71.4% of cases. PAC usage was notably higher in patients who received isolated off-pump CABG and in institutions with higher annual case volume (Figures 1 and 2). The overall incidence rate of 1-year all-cause postoperative mortality was 8.6% (4,234/49,027) and 13.5% (2,658/19,689) in the PAC and no PAC groups, respectively. After adjusting for confounders through PSM, the risk of 1-year all-cause mortality in the PAC group was significantly lower than in the no PAC group (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.74–0.84; P<0.001). In subgroup analyses, the type of cardiac surgery and institutional case volume were identified as significant modifiers for the association between the perioperative PAC use and 1-year all-cause mortality after cardiac surgery (P for interaction 0.001 and <0.001, respectively). PAC was found to significantly lower the risk of 1-year all-cause mortality after isolated off-pump CABG (adjusted OR, 0.66; 95% CI, 0.56–0.77), isolated on-pump CABG (0.82; 0.72–0.93), and isolated thoracic aorta (0.73; 0.64–0.82). In addition, PAC use in lower case volume centers (<100 cases/year) was associated with a lower risk of 1-year all-cause mortality (adjusted OR 0.70; 95% CI 0.65–0.75), but not in higher case volume centers. Despite the guidelines recommending selective application of PAC, our study demonstrated that PAC is still frequently used in modern cardiac surgery practice. We found that PAC use was associated with reduced postoperative mortality, particularly in isolated CABG and thoracic aorta surgeries and lower case volume centers. [ABSTRACT FROM AUTHOR]