Roger Irvine

Acute renal failure post coronary artery bypass grafting at the University Hospital of the West Indies

OBJECTIVES The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors. METHOD A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications. RESULTS The case notes of 62 patients (68.9%) were obtained for analysis. There were 47 (75.8%) males and 15 females (24.2%)--a 3:1 ratio. The prevalence of HTN and DM in the study sample was 78% and 72% respectively, hypercholesterolaemia was 31% and a previous MI was 29%. There were no differences based on gender. Post CABG complications were: persistent postoperative hypotension (6.8%), congestive cardiac failure (CCF) (6.8%), arrhythmia (6.8%), sepsis (6.8%), lower respiratory tract infection (LRTI) and pleural effusion (5.1%), heart block (3.4%), pulmonary embolism (1.7%), cellulitis and haematoma formation were 1.7%. Three patients had increases in postoperative creatinine values > 89 micromol/L over the postoperative value resulting in a prevalence of ARF of 5%. One of the three patients died and none received dialysis. There were no statistical difference in pre-operative clinical and biochemical characteristics based on the presence or absence of ARE. The presence of diabetes and increased length of stay were significant predictors of increasing postoperative creatinine values adjusting for pre-operative creatinine values. In addition, the presence of diabetes mellitus and male gender were significant predictors of increasing postoperative urea values. CONCLUSION DM is a significant risk factor for the development of ARF post CABG.

Coronary Artery Bypass Graft Surgery at the University Hospital of the West Indies, Jamaica: Analysis of Clinical Characteristics, Mortality and Length of Hospital Stay

Objectives: A detailed analysis of coronary artery bypass graft (CABG) surgical cases performed at the University Hospital of the West Indies (UHWI) has never been conducted. We present the demographic profile, clinical characteristics, and outcome of cases performed during the period March 2010 to March 2016. Methods: Data from consecutive CABG surgeries performed during the study period were collected prospectively, entered into a computerized database and then analyzed. Outcome measures were 30-day operative mortality, ICU length of stay (ICU LOS) and total postoperative length of stay (PostOp LOS). Results: Of the 190 patients comprising the study population, 68.9% were males, and mean age (SD) was 61.3 (±10.2) years. The most frequent co-morbidities and risk factors were hypertension (82.1%) and diabetes (55.3%), cigarette smoking (33.7%) and hyperlipidaemia (89%). Left ventricular ejection fraction (LVEF) was found to be grades 1(good), 2(moderate), and 3(poor) in 50%, 44.2%, and 5.8% of patients, respectively. The majority (83%) were diagnosed with triple vessel disease. The crude, unadjusted 30-day mortality rate was 8.4%. Using the Canadian Risk Index Model, the mortality rates were: low risk (0-3), 5.5%; medium risk (4-7), 14.3%; and high risk (>8), 100%. The median ICU LOS and median postoperative LOS were 3 days (IQR, 2-4), and 8 days (IQR, 6-11), respectively. Logistic regression analysis revealed that grade 2 LVEF and urgent/emergent operations were predictors of mortality, female gender predictive of prolonged ICU LOS, and advanced age and female gender of borderline significance for prolonged PostOp LOS. Conclusion: This analysis of outcome of CABG cases performed at the UHWI provides an indication of current performance and serves as a benchmark against which future studies may be compared to determine the efficacy of future quality improvement initiatives.