Duration of Cardiopulmonary Bypass and Outcome

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To the Editor:

Kumar et al performed a meta-analysis modeling the association between the duration of cardiopulmonary bypass (the dependent variable) and the presence/absence of acute kidney injury (the independent variable).¹ Stratification was not made by the surgical procedure. To obtain an unbiased estimate for the association between duration and outcome, the procedures need to be tested for inclusion in the statistical model.² The testing needs to include procedures defined in sufficient detail to differentiate between effects on the outcome of procedures of different durations versus longer durations per se.² The conclusion that “longer cardiopulmonary bypass times are associated with a higher risk of developing acute kidney injury” requires additional investigation.

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References 

1. Kumar AB , Suneja M , Bayman EO , et al.  Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: A meta-analysis . J Cardiothorac Vasc Anesth . 2012;26:64–69
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2. Dexter F , Dexter EU , Ledolter J . Importance of appropriately modeling procedure and duration in logistic regression studies of perioperative morbidity and mortality . Anesth Analg . 2011;113:1197–1201
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