Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality

Haytham Elgharably*, Maysoon Gamaleldin, Kamal S. Ayyat, Anthony Zaki, Kevin Hodges, Bogdan Kindzelski, Shashank Sharma, Tarek Hassab, Camille Yongue, Solanus de la Serna, Juan Perez, Capri Spencer, Faisal G. Bakaeen, Scott R. Steele, A. Marc Gillinov, Lars G. Svensson, Gosta B. Pettersson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

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. 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. 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. Conclusions: Although relatively uncommon, severe forms of GICs are associated with high mortality. Early recognition and aggressive treatment are mandatory to improve outcomes.

Original languageEnglish (US)
Pages (from-to)1266-1274
Number of pages9
JournalAnnals of Thoracic Surgery
Volume112
Issue number4
DOIs
StatePublished - Oct 2021

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

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