Weekend effect on the incidence and outcomes of cardiac surgery associated - acute kidney injury

Qiwen Xie; Ziyan Shen; Mingzhen Pan; Yang Li; Zhe Luo; Chunsheng Wang; Linxi Zhao; Yi Fang; Xiaoqiang Ding; Jie Teng; Jiarui Xu

doi:10.1186/s12872-023-03431-4

Weekend effect on the incidence and outcomes of cardiac surgery associated - acute kidney injury

BMC Cardiovasc Disord. 2023 Oct 27;23(1):524. doi: 10.1186/s12872-023-03431-4.

Authors

Qiwen Xie^#¹, Ziyan Shen^#², Mingzhen Pan^#³, Yang Li², Zhe Luo⁴, Chunsheng Wang⁵, Linxi Zhao⁶, Yi Fang^{1

2}, Xiaoqiang Ding^{1

2}, Jie Teng^{7

8}, Jiarui Xu⁹

Affiliations

¹ Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Nephrology Clinical Quality Control Center of Xiamen, No.668 Jinhu Road, Xiamen, 361006, Fujian, China.
² Department of Nephrology, Zhongshan Hospital, Fudan University; Kidney and Dialysis Institute of Shanghai; Kidney and Blood Purification Laboratory of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China.
³ Department of Nephrology, The Second People's Hospital of Kashgar, Xinjiang, 844000, China.
⁴ Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
⁵ Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
⁶ Hopewell Eye Associates, 84 East Broad St, Hopewell, NJ, 08525, USA.
⁷ Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Nephrology Clinical Quality Control Center of Xiamen, No.668 Jinhu Road, Xiamen, 361006, Fujian, China. teng.jie@zs-hospital.sh.cn.
⁸ Department of Nephrology, Zhongshan Hospital, Fudan University; Kidney and Dialysis Institute of Shanghai; Kidney and Blood Purification Laboratory of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China. teng.jie@zs-hospital.sh.cn.
⁹ Department of Nephrology, Zhongshan Hospital, Fudan University; Kidney and Dialysis Institute of Shanghai; Kidney and Blood Purification Laboratory of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China. xu.jiarui@zs-hospital.sh.cn.

^# Contributed equally.

Abstract

Background: The effects of surgical day (workdays or weekends) on occurrence and outcome of cardiac surgery associated -acute kidney injury (CSA-AKI) remains unclear. This study aimed to compare the incidence and short-term outcomes of CSA-AKI in patients undergoing surgery on workdays and weekends.

Materials and methods: Patients who underwent cardiac surgery from July 2020 to December 2020 were retrospectively enrolled in this study. These patients were divided into a weekend group and workday group. The primary endpoint was the incidence of CSA-AKI. The secondary endpoints included renal function recovery and in-hospital mortality. The logistic regression model was used to explore the risk factors for CSA-AKI. Stratification analysis was performed to estimate the association between CSA-AKI and weekend surgery stratified by emergency surgery.

Results: A total of 1974 patients undergoing cardiac surgery were enrolled. The incidence of CSA-AKI in the weekend group was significantly higher than that in the workday group (42.8% vs. 34.7%, P = 0.038). Further analysis of patients with CSA-AKI showed that there was no difference in renal function recovery between the workday AKI group and weekend AKI group. There was no difference in in-hospital mortality between the weekend group and workday group (3.6% vs. 2.4%, P = 0.327); however, the in-hospital mortality of the weekend AKI group was significantly higher than that of the workday AKI group (8.5% vs. 2.9%, P = 0.014). Weekend surgery and emergency surgery were independent risk factors for CSA-AKI. The multiplicative model showed an interaction between weekend surgery and emergency surgery; weekend surgery was related to an increased risk of AKI among patients undergoing emergency surgery [adjusted OR (95% CI): 1.96 (1.012-8.128)].

Conclusions: The incidence of CSA-AKI in patients undergoing cardiac surgery on weekends was significantly higher compared to that in patients undergoing cardiac surgery on workdays. Weekend surgery did not affect the in-hospital mortality of all patients but significantly increased the mortality of AKI patients. Weekend surgery and emergency surgery were independent risk factors for CSA-AKI. Weekend emergency surgery significantly increased the risk of CSA-AKI.

Keywords: Acute kidney injury; Cardiac surgery; Emergency surgery; Short-term outcome; Weekend.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Cardiac Surgical Procedures* / adverse effects
Humans
Incidence
Postoperative Complications / etiology
Retrospective Studies
Risk Factors