Intestinal ischemia after cardiac surgery: analysis of a large registry

Abstract

BackgroundIntestinal ischemia after cardiac surgery is a rare but severe complication with a high mortality. Early surgery can be lifesaving. The aim was to analyze the incidence, outcome, and risk factors for these patients.MethodsA prospectively collected database with patients who underwent 18,879 cardiac surgical procedures between 1996 and 2011 was investigated. All patients with registered gastrointestinal complications were retrospectively reviewed. Univariate and multivariate analyses were performed to compare patients with and without intestinal ischemia.ResultsSeventeen patients suffered from intestinal ischemia (0.09%), 10 of whom (59%) died. By investigating preoperative parameters independent risk factors were steroids, peripheral vascular disease, cardiogenic shock, and New York Heart Association class 4. When including pre-, per-, and postoperative parameters, only postoperative ones were significant, including elevated creatinine (> 200 μmol/L), prolonged ventilator time, need for intra-aortic balloon pump, and cerebrovascular insult (CVI). The gastrointestinal complications score (GICS) showed a ROC area of 0.87. This was superior compared with EuroSCORE (0.74), to predict intestinal ischemia.ConclusionsIntestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients.

Death in low-risk cardiac surgery revisited

“…Intestinal ischaemia after cardiac surgery is known to be a rare but severe complication with a high mortality. 17 Overall, a 30-day mortality of 0.35% is an acceptable result in low-risk patients, and in line with previous reports. However, 55% of these cases were found to be potentially preventable suggesting that there is a clear potential for further improvement.…”

Impact of preoperative defecation pattern on postoperative constipation for patients undergoing cardiac surgery

“…Gastrointestinal complications caused by intestinal ischaemia occur rarely after cardiac surgeries but may cause morbidity and mortality (Nilsson et al 2013). However, constipation, which occurs frequently after cardiac surgeries and which holds an important place among gastrointestinal problems, is mostly neglected (Rasmussen & Pedersen 2010).…”

Predicción de Lesión Renal Aguda asociada a Cirugía Cardíaca: la Escala CRATE

“…Son complicaciones poco frecuentes en el contexto del paciente cardíaco (0,5% a 1,5%). Las más frecuentes son sangrado gastrointestinal bajo, pancreatitis aguda, colecistitis, perforación del tracto gastroinestinal, ileo paralítico, isquemia, y fallo hepático [52]. La fisiopatología de estas alteraciones está relacionada con periodos de isquemia derivados de estados de bajo gasto cardíaco y fenómenos embólicos [53].…”