TY - JOUR
T1 - Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality
AU - Elgharably, Haytham
AU - Gamaleldin, Maysoon
AU - Ayyat, Kamal S.
AU - Zaki, Anthony
AU - Hodges, Kevin
AU - Kindzelski, Bogdan
AU - Sharma, Shashank
AU - Hassab, Tarek
AU - Yongue, Camille
AU - Serna, Solanus de la
AU - Perez, Juan
AU - Spencer, Capri
AU - Bakaeen, Faisal G.
AU - Steele, Scott R.
AU - Gillinov, A. Marc
AU - Svensson, Lars G.
AU - Pettersson, Gosta B.
N1 - Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2020.09.034
DO - 10.1016/j.athoracsur.2020.09.034
M3 - Article
C2 - 33217398
AN - SCOPUS:85101316541
SN - 0003-4975
VL - 112
SP - 1266
EP - 1274
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -