Frequency of Early Acute Kidney Injury After On-Pump Coronary Artery Bypass Grafting: A Comparison Between Minimally Invasive and Conventional Median Sternotomy
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Background: Acute kidney injury is a frequent complication of cardiac surgery and may be influenced by patient characteristics, cardiopulmonary bypass, perioperative hemodynamics, and operative factors. Objective: To compare the frequency and severity of early AKI after on-pump CABG performed through minimally invasive anterior minithoracotomy and conventional median sternotomy. Methods: This comparative observational study included 150 patients undergoing elective on-pump CABG at two centers, with 75 patients in each surgical group. Serum creatinine was assessed preoperatively and at 24, 48, and 72 hours; eGFR, urea, BUN, and urine output were also evaluated. AKI was classified according to KDIGO criteria. Continuous and categorical outcomes were compared between groups, and crude effect estimates were calculated for AKI. Results: AKI occurred in 10/75 (13.3%) minimally invasive patients and 36/75 (48.0%) conventional patients (p<0.001), corresponding to a crude RR of 3.60 (95% CI 1.93–6.71) and OR of 6.00 (95% CI 2.68–13.42) for conventional surgery. KDIGO stages 2–3 occurred in 4.0% versus 17.3%. At 48 hours, creatinine was 1.26±0.58 versus 1.92±1.15 mg/dL, while eGFR was 67.67±22.68 versus 48.59±24.14 mL/min/1.73 m². The 48-hour creatinine increase was also smaller after minimally invasive CABG (0.26±0.52 vs 0.76±1.02 mg/dL; p<0.001). Conclusion: Minimally invasive CABG was associated with less early postoperative renal dysfunction; however, baseline renal differences and the observational design limit causal interpretation
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