Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis

Abstract

Background Gastrointestinal complications following on-pump cardiac surgery are orphan but serious risk factors for postoperative morbidity and mortality. We aimed to assess incidence, perioperative risk factors, treatment modalities and outcomes. Material and methods A university medical center audit comprised 4883 consecutive patients (median age 69 [interquartile range IQR 60–76] years, 33% female, median logistic EuroScore 5 [IQR 3–11]) undergoing all types of cardiac surgery including surgery on the thoracic aorta; patients undergoing repair of congenital heart disease, implantation of assist devices or cardiac transplantation were excluded. Coronary artery disease was the leading indication for on-pump cardiac surgery (60%), patients undergoing cardiac surgery under urgency or emergency setting were included in analysis. We identified a total of 142 patients with gastrointestinal complications. To identify intra- and postoperative predictors for gastrointestinal complications, we applied a 1:1 propensity score matching procedure based on a logistic regression model. Results Overall, 30-day mortality for the entire cohort was 5.4%; the incidence of gastrointestinal complications was 2.9% and median time to complication 8 days (IQR 4–12). Acute pancreatitis (n = 41), paralytic ileus (n = 14) and acute cholecystitis (n = 18) were the leading pathologies. Mesenteric ischemia and gastrointestinal bleeding accounted for 16 vs. 18 cases, respectively. While 72 patients (51%) could be managed conservatively, 27 patients required endoscopic/radiological (19%) or surgical intervention (43/142 patients, 30%); overall 30-day mortality was 12.1% (p<0.001). Propensity score matching identified prolonged skin-to-skin times (p = 0.026; Odds Ratio OR 1.003, 95% Confidence Interval CI 1.000–1.007) and extended on-pump periods (p = 0.010; OR 1.006, 95%CI 1.001–1.011) as significant perioperative risk factors. Comment Prolonged skin-to-skin times and extended on-pump periods are important perioperative risk factors regardless of preoperative risk factors.

Early Onset of Postoperative Gastrointestinal Dysfunction Is Associated With Unfavorable Outcome in Cardiac Surgery: A Prospective Observational Study

“…The ECC time is an established risk factor for GI complications. 24,25 The present study provides evidence for the hypothesis that GI dysfunction precedes GI complications since more than 60% of the patients in the AGI !2 group later developed GI complications. The overall incidence of acute mesenteric ischemia was 0.4%, which is in line with previous studies.…”

Gastrointestinal complications following cardiac surgery

“…Previous studies have shown a strong correlation between preoperative EuroSCORE values and GI complications. 44,45 It is therefore essential that preoperative risk assessment is carried out, so both patients and staff are prepared to deal with any subsequent complications. Preexisting GI conditions such as ulcers and hemorrhoids have also been found to be associated with a higher rate of upper and lower GI bleeding, respectively.…”

“…Preexisting GI conditions such as ulcers and hemorrhoids have also been found to be associated with a higher rate of upper and lower GI bleeding, respectively. 44 Other methods to potentially reduce the risk of complications include the use of a PPI to reduce the risk of duodenal and peptic ulcers. In a randomized controlled trial including 210 patients undergoing cardiac surgery, those who were administered a PPI had fewer active ulcers (4.3%) compared to patients given histamine type 2 receptor antagonists (21.4%) or a mucosal protector (28.6%).…”

“…5 Optimization of the patient’s hemodynamic state should also be ensured because an increase in perioperative hemodynamic instability and postoperative GI complications has been reported previously. 45 Goal-directed therapy involves correction of hypovolemia and potentially using inotrope therapy to achieve normal hemodynamic parameters, thereby maintaining systemic oxygenation and protecting organs such as the GI tract, which are at risk of hypoperfusion. In a meta-analysis of randomized controlled trials using a random effects model by Giglio and colleagues, 49 goal-directed therapy was shown to significantly reduce both minor and significant GI complications.…”

Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes

“…Gastrointestinal (GI) complications are uncommon, but potentially highly morbid events following cardiac surgery procedures 1 . The reported incidence of these events is between 0.5% and 4.5% of cardiac cases, but the in‐hospital mortality associated with GI complications is around 30%–40%, with some series reporting higher rates of mortality 2–8 . Previous series have identified several risk factors such as increasing age and comorbidity, as well as and prolonged operation times as risk factors for the development of GI complications 3,4,7 .…”