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Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2021 Oct; Vol. 112 (4), pp. 1266-1274. Date of Electronic Publication: 2020 Nov 18. - Publication Year :
- 2021
-
Abstract
- Background: Severe gastrointestinal (GI) complications (GICs) after cardiac surgery are associated with poor outcomes. Herein, we characterize the severe forms of GICs and associated risk factors of mortality.<br />Methods: We retrospectively analyzed the clinically significant postoperative GICs after cardiac surgical procedures performed at our institution from January 2010 to April 2017. Multivariable analysis was used to identify predictors for in-hospital mortality.<br />Results: Of 29,909 cardiac surgical procedures, GICs occurred in 1037 patients (3.5% incidence), with overall in-hospital mortality of 14% compared with 1.6% in those without GICs. GICs were encountered in older patients with multiple comorbidities who underwent complex prolonged procedures. The most lethal GICs were mesenteric ischemia (n = 104), hepatopancreatobiliary (HPB) dysfunction (n = 139), and GI bleeding (n = 259), with mortality rates of 45%, 27%, and 17%, respectively. In the mesenteric ischemia subset, coronary artery disease (odds ratio [OR], 4.57; P = .002], coronary bypass grafting (OR, 6.50; P = .005), reoperation for bleeding/tamponade (OR, 12.07; P = .01), and vasopressin use (OR, 11.27; P < .001) were predictors of in-hospital mortality. In the HPB complications subset, hepatic complications occurred in 101 patients (73%), pancreatitis in 38 (27%), and biliary disease in 31 (22%). GI bleeding occurred in 20 patients (31%) with HPB dysfunction. In the GI bleeding subset, HPB disease (OR, 10.99; P < .001) and bivalirudin therapy (OR, 12.84; P = .01) were predictors for in-hospital mortality.<br />Conclusions: Although relatively uncommon, severe forms of GICs are associated with high mortality. Early recognition and aggressive treatment are mandatory to improve outcomes.<br /> (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Severity of Illness Index
Cardiac Surgical Procedures adverse effects
Gastrointestinal Diseases etiology
Gastrointestinal Diseases mortality
Postoperative Complications etiology
Postoperative Complications mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 112
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33217398
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2020.09.034