Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy

Abstract

Background:Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is associated with high mortality. We investigated the incidence of hyperbilirubinaemia after two major types of thoracic surgery: open-heart surgery and oesophagectomy. In order to identify the risk factors associated with hyperbilirubinaemia after major surgery, we compared the incidence after open-heart surgery with that after oesophagectomy.Results:Hyperbilirubinaemia was detected in 51% of the open-heart surgery patients (n = 133) and in 64% in the oesophagectomy group (n = 74). The incidence of hyperbilirubinaemia was significantly related to the duration of surgery (P< 0.05). In the open-heart surgery group, duration of surgery was 465 ± 24 min for the patients without hyperbilirubinaemia and 571 ± 26 min for the patients with hyperbilirubinaemia. In the oesophagectomy group, the procedure durations were 415 ± 17 min and 493 ± 20 min, respectively. The overall mortality rate was 8% in the open-heart surgery group; the rate was 12% in those with hyperbilirubinaemia, but 5% in those without hyperbilirubinaemia. No members of the oesophagectomy group died, with or without hyperbilirubinaemia. Infection significantly affected both the occurrence of hyperbilirubinaemia and mortality in the open-heart surgery group. In the subgroups from the open-heart surgery group, 5% (three out of 65) of those without hyperbilirubinaemia (or evidence of infection) died; of the patients with hyperbilirubinaemia, 3% (one out of 38) of those without infection died and 23% (seven out of 30) with detected infection died.Conclusion:After open-heart surgery and oesophagectomy, approximately half of the patients studied had higher levels of serum total bilirubin. Time spent in surgery was significantly related to the occurrence of hyperbilirubinaemia. Infection significantly affected mortality and total bilirubin levels after open-heart surgery. Control of infection plays a crucial role in the prevention of hyperbilirubinaemia and in reducing mortality.

Frequency, Risk Factors and Prognosis of Postoperative Hyperbilirubinemia after Heart Valve Surgery

“…Postoperative hyperbilirubinemia has been reported to occur in 3–35% of cardiovascular surgery patients [1,2,3,4,5,6,7,8,9,10,11], mostly with a rate greater than 20%. In addition, the rate of incidence in patients who have undergone heart valve surgery has been reported to be even higher than in those who did not, ranging from 30–40% [6,9,13].…”

“…Despite recent advances in surgical techniques and perioperative management, the incidence of postoperative hyperbilirubinemia after open-heart surgery is estimated to be nearly 20% [1,2,3,4,5,6,7,8,9,10], which has been consistent since the first report in 1967 [1,2]. Previous studies have suggested a number of possible risk factors underlying the development of postoperative hyperbilirubinemia, including age, heart failure [10,11], cardiopulmonary bypass time [9,10], transfusion [6,9], hemolysis [6] and sepsis [1].…”

Hyperbilirubinemia predicts the infectious complications after esophagectomy for esophageal cancer

“…Early detection and appropriate management to prevent the aggravation of PICs might be necessary to achieve favorable long-term outcomes after highly invasive esophagectomy with LN dissection for esophageal cancer. Several studies have already reported that hyperbilirubinemia is associated with not only major thoracic surgery such as esophagectomy but also post-esophagectomy complications [ 11 , 12 ]. We conducted this retrospective study to elucidate the clinical significance of postoperative hyperbilirubinemia especially in the management of patients with esophageal cancer after esophagectomy.…”

“…It has been shown that surgical stress and inflammation after major surgery cause postoperative hyperbilirubinemia [ 10 ]. In addition, several studies have elucidated that postoperative hyperbilirubinemia is associated with the extent of surgery and postoperative complications [ 11 , 12 ]. However, the clinical implication of postoperative hyperbilirubinemia in the management of these patients has not yet been clarified.…”

Pharmaconutrition with Omega-3 Fatty Acids: Status Quo and Further Perspectives

“…Poeze and colleagues demonstrated that increased transaminases and bilirubin precede the development of organ dysfunction after elective high-risk surgery [51] and hyperbilirubinaemia was associated with a two-fold duration of ICU-stay [52] and an increased incidence of complications after esophageal resection. Moreover, inadequate hyperactivation of the APR in patients with unresectable pancreatic cancer was associated with shorter time of survival.…”