Predictors and Outcome of Gastrointestinal Complications in Patients Undergoing Cardiac Surgery

Filsoufi, Farzan; Rahmanian, Parwis B.; Castillo, Javier G.; Scurlock, Corey; Legnani, Peter; Adams, David H.

doi:10.1097/sla.0b013e3180603010

Cited by 106 publications

(94 citation statements)

References 13 publications

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“…Previous studies 6,7 often focused on preoperative variables, but some perioperative variables may have greater effects than others on patient mortality. As our analysis in Maintenance hemodialysis patients with residual urine output had better postoperative survival than anuric patients did.…”

Section: Discussionmentioning

confidence: 99%

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Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Lin

Ko³

et al. 2009

American Journal of Critical Care

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BackgroundThe relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown. Objective To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients. Methods A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dial ysis. Propensity scores for postoperative anuria were developed. Results Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to non anuria (P = .03) and 5.13 for preoperative anuria vs non anuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045). Conclusion Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity. (American Journal of Critical Care. 2009;18:446-455) The focus of concerns about acute dialysis-related mortality has often been patients' disease severity before surgery.6,7 However, perioperative hemodynamic status and biochemical factors are also related to such patients' mortality, especially in patients with ESRD. Although many factors are related to surgical mortality in patients with ESRD, 8 information on the relationship between RRF and mortality in ESRD patients who undergo a major surgical procedure is limited. In addition, whether perioperative RRF independently is predictive of mortality after major surgery is not known. According to Shemin et al, 5 renal function, as measured by timed urine collections, can have either a beneficial or a protective effect in hemodialysis patients. The role of residual urine output (RUO) in hemodialysis patients is often neglected, and it remains unknown whether the results of survival studies in hemodialysis patients with anuria can be extrapolated to hemodialysis patients who still have RUO after major surgery.Because the amount of urine can be measured accurately in the intensive care unit (ICU), 9 we attempted to gauge RRF by RUO and examined the predictive value of postoperative anuria for ICU mortality among maintenance hemodialys...

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Section: Discussionmentioning

confidence: 99%

“…6,7 However, perioperative hemodynamic status and biochemical factors are also related to such patients' mortality, especially in patients with ESRD. Although many factors are related to surgical mortality in patients with ESRD, 8 information on the relationship between RRF and mortality in ESRD patients who undergo a major surgical procedure is limited.…”

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confidence: 99%

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Lin

Ko³

et al. 2009

American Journal of Critical Care

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“…Many GI complications are reported, with only few studies addressing specifically upper GI bleeding in this context [1][2][3]. Moreover, the generalizability of past study findings is limited by differences between the supportive cares administered over a decade ago versus today.…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Amorim

Barkun

Larocque

et al. 2012

Ulcers

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Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

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“…The frequency following such operations is rare (0.49-2.00%) [1][2][3]; however, the mortality from acute mesenteric ischaemia of any aetiology is high at 70-100%, even for patients managed in specialist tertiary referral centres [4][5][6]. Although there has been a recent move away from coronary artery bypass graft (CABG) surgery to percutaneous transluminal coronary intervention, there has been an increase in the number of complex CABG surgical procedures performed, e.g.…”

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confidence: 99%

“…CABG with mixed valve replacement. This, combined with an ageing patient population with associated increased comorbidities and risk factors, may lead to a rise in the incidence of ischaemic bowel in patients following CPB surgery [3]. Furthermore, definitive radiological diagnosis is known to be difficult in such patients [7].…”

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confidence: 99%

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Barrett¹,

Upponi²,

Benaglia³

et al. 2013

BJR

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Objective: To investigate CT findings in patients with pathologically proven mesenteric ischaemia postcardiopulmonary bypass surgery and compare them with the control group of patients without ischaemia. Methods: 68 patients were identified by a search of local surgical and pathological databases; these patients met the inclusion criteria of a laparotomy within 1 month of a procedure requiring cardiopulmonary bypass and a CT abdomen/pelvis within 1 week of the pathological diagnosis. Two radiologists independently reviewed the studies, evaluating 17 separate findings relating to the bowel, the vasculature or other structures; consensus was subsequently reached. The diagnostic value of CT findings was assessed using logistic regression. Results: 52 of 68 patients had pathologically proven ischaemia. Portal venous gas, mesenteric venous gas and small bowel faeces sign all had specificities of .0.94 for ischaemia but low sensitivity (,0.27). Differential mural enhancement had high sensitivity (0.92) but poor specificity (0.50). The combination of pneumatosis, bowel loop dilatation and differential mural enhancement predicted bowel ischaemia with a probability of 98%. The hardest signs to interpret based on poor interreader kappa agreement were bowel wall thinning, mesenteric stranding and differential mural enhancement. Conclusion: A combination of CT signs was predictive of ischaemic bowel; however, the more specific findings lacked sensitivity. If clinical suspicion is high for bowel ischaemia, prompt surgical intervention is warranted, regardless of CT findings. Advances in knowledge: Arterial occlusion was uncommon and venous occlusion was not present, which is supportive of a predominantly non-occlusive aetiology for ischaemia in this patient group.

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Predictors and Outcome of Gastrointestinal Complications in Patients Undergoing Cardiac Surgery

Cited by 106 publications

References 13 publications

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

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