Using a quality improvement initiative to reduce acute kidney injury during on-pump coronary artery bypass grafting

Abstract

Introduction:

In response to a perceived high incidence of acute kidney injury following cardiopulmonary bypass at our institution, a quality improvement initiative consisting of a systematic change to a delivered oxygen (DO₂) goal-directed perfusion practice was implemented. We sought to maintain DO₂ > 270 mL/min/m² to reduce the incidence of acute kidney injury.

Methods:

’The study population included all patients receiving isolated, non-emergent, on-pump coronary artery bypass grafting from January 2015 through December 2018, excluding patients requiring preoperative hemodialysis. DO₂ goal-directed perfusion was instituted in February 2017. Acute kidney injury was defined using Acute Kidney Injury Network criteria.

Results:

The pre–goal-directed perfusion cohort included 257 patients, and the post–goal-directed perfusion cohort included 226 patients. The DO₂ was significantly higher in the post–goal-directed perfusion group (p < 0.001). Postoperative change in serum creatinine and incidence of acute kidney injury were significantly lower in the post–goal-directed perfusion group (p < 0.001, p = 0.001, respectively). Estimation with probit and ordered probit models support these findings.

Conclusion:

This initiative confirms previous assertions that DO₂ is a critical intraoperative parameter and should direct perfusion intervention accordingly.

Keywords

cardiopulmonary bypass acute kidney injury delivered oxygen goal-directed perfusion quality improvement cardiac surgery

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