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.
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)].
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.
方法:回顾性纳入2020年7月至2020年12月接受心脏手术的患者。将这些患者分为周末组和工作日组。主要终点是CSA-AKI的发生率。次要终点包括肾功能恢复和院内死亡率。采用logistic回归模型探讨CSA-AKI的危险因素。进行分层分析以估计CSA-AKI与急诊手术分层的周末手术之间的关联。
结果:共纳入1974例心脏手术患者。周末组CSA-AKI发生率明显高于工作日组(42.8%vs.34.7%,P=0.038)。对CSA-AKI患者的进一步分析显示,工作日AKI组与周末AKI组的肾功能恢复无差异。周末组和工作日组的住院死亡率没有差异(3.6%vs.2.4%,P=0.327);然而,周末AKI组的住院死亡率明显高于工作日AKI组(8.5%vs.2.9%,P=0.014)。周末手术和急诊手术是CSA-AKI的独立危险因素。乘法模型显示周末手术和急诊手术之间的相互作用;周末手术与急诊手术患者的AKI风险增加相关[调整后OR(95%CI):1.96(1.012-8.128)]。
结论:周末心脏手术患者的CSA-AKI发生率明显高于工作日心脏手术患者。周末手术不影响所有患者的院内死亡率,但显著增加了AKI患者的死亡率。周末手术和急诊手术是CSA-AKI的独立危险因素。周末急诊手术显著增加CSA-AKI的风险。