Risk factor analysis and risk prediction model of cardiac surgery-associated acute kidney injury after Da Vinci robotic cardiac surgery
Authors: Wu Wenjun , Ding Renzhong , Chen Jianming , Yuan Ye , Song Yi , Yan Manrong , Hu Yijie 
Published: September 2022

Background
To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the risk factors of postoperative cardiac surgery-associated acute kidney injury (CSA-AKI) and to establish a risk prediction model.
Methods
The data of 147 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Military Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (43.03 ± 13.11) years, 55 (37.41%) were male and 92 (62.59%) were female. Patients were divided into 2 groups according to whether CSA-AKI occurred after surgery: 37 patients developed CSA-AKI and 109 patients did not develop CSA-AKI. Univariate analysis was performed for perioperative risk factors in the two groups, and then multivariate logistic analysis was performed for selected variables with more significance to establish a regression model and evaluate the prediction model using receiver operating characteristic curve (ROC curve).
Results
37 of 147 patients (25.34%) developed CSA-AKI after Da Vinci robotic cardiac surgery, 28 (19.18%) had stage 1 CSA-AKI, 6 (4.11%) had stage 2 CSA-AKI, 3 (2.05%) had stage 3 CSA-AKI, 1 (0.68%) had renal failure dialysis, and 1 (0.68%) died in the hospital.Univariate analysis of CSA-AKI after Da Vinci robotic cardiac surgery suggested that age, gender, obesity class, hypertension, smoking, alcohol consumption, New York Heart Association (NYHA) class, left atrial anteroposterior diameter (LAD), triglyceride (TG), high-density lipoprotein (HDL), alanine aminotransferase (ALT), creatinine (SCr), operation time, aortic cross-clamp time, CPB time, and operation type were statistically analyzed and associated with postoperative CSA-AKI (P < 0.05).Multivariate binary logistic regression analysis suggested that preoperative TG (OR = 1.756, 95%CI 1.058 ~ 2.914, P = 0.029) and operation time ≥ 300 min (OR = 3.649, 95%CI 1.061 ~ 12.553, P = 0.04) were independent risk factors for CSA-AKI after Da Vinci robotic cardiac surgery.In the CSA-AKI group, the postoperative tracheal intubation time (P < 0.001), intensive care unit stay (P = 0.004), and postoperative hospital stay (P = 0.002) were significantly prolonged, the incidence of postoperative pulmonary infection (P = 0.029), liver function injury (P = 0.045), and hypoproteinemia (P = 0.007) was significantly increased, and postoperative high-dose transfusion events were significantly increased (P = 0.002).The area under the curve (AUC) of ROC was 0.8 (95%CI 0.714 ~ 0.886, P < 0.001), the cutoff point was 0.456, the model sensitivity was 67.6%, and the specificity was 78%.
Conclusion
Preoperative TG and operation time ≥ 300 min were independent risk factors of CSA-AKI after Da Vinci robotic cardiac surgery; postoperative tracheal intubation time, intensive care unit stay and postoperative hospital stay were significantly prolonged in patients with postoperative CSA-AKI, the incidence of postoperative pulmonary infection, liver function injury and hypoproteinemia was significantly increased, and postoperative high-dose blood transfusion events were significantly increased; the risk prediction model had certain predictive value for postoperative CSA-AKI.