New England Surgical Society

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Ischemic Gastrointestinal Complications in Patients Undergoing Open Cardiac Surgical Procedures: A Single-Center Experience of 6,862 Consecutive Patients
*Leon Naar, *Napaporn Kongkaewpaisan, *Nikolaos Kokoroskos, *George Tolis, *Serguei Melnitchouk, *Mauricio Villavicencio-Theoduloz, *April E. Mendoza, *George Velmahos, Haytham Kaafarani, *Arminder Singh Jassar
Massachusetts General Hospital, Harvard Medical School, Boston, MA

Objective: Ischemic gastrointestinal complications (IGIC) after cardiac surgery are rare, can present with a wide spectrum of symptoms, and are life-threatening. Perioperative risk-stratification for IGIC may improve outcomes through the development of mitigation strategies and early interventions. In this study, we sought to identify risk factors for IGIC.Design: Retrospective institutional cohort study.Setting: Tertiary academic center. Patients: Patients that underwent open cardiac surgical procedures (2011-2017).Intervention(s): N/AMain outcome measure(s): Primary outcome was IGIC, defined as ischemic colitis requiring blood transfusions and/or mesenteric ischemia requiring operative interventions. A stepwise regression model was constructed to identify independent predictors of IGIC.Results: Of 6,862 patients who underwent cardiac surgery during the study period, 52(0.8%) developed IGIC [25(48%) underwent an operative intervention and in 10(19%) surgery was deemed futile]. The highest incidence of IGIC(1.85%) was noted in patients undergoing a simultaneous coronary artery, valvular, and aortic procedure. Median duration from procedure to diagnosis of IGIC was 8[5-14] days. In-hospital mortality was significantly higher in patients with IGIC (58.8% vs. 3.1%,p<0.001). The results of the multivariable regression controlling for demographics, comorbidities, intra-operative parameters, and medication, are summarized in Table 1. Cardiorespiratory and renal comorbidities, immunosuppression, cardiopulmonary bypass
(CPB)>180 minutes, pre- or intra-operative utilization of intra-aortic devices, and intraoperative>4 RBC transfusions were identified as independent predictors of IGIC.Conclusions: Immunocompromised status, CPB>180 minutes, intraoperative>4 RBC transfusions, and pre- or intra-operative intra-aortic devices are high-risk features for postoperative IGIC in cardiac surgery. A high index of suspicion may lead to earlier identification and more aggressive interventions that could potentially improve outcomes.

Odds RatioP-value95% Conf. Intervals
Age1.030.0681.00-1.06
Body Mass Index0.940.0720.88-1.01
Dyslipidemia0.430.0270.20-0.91
Hypertension5.740.0071.60-20.59
Chronic lung disease2.610.0071.30-5.23
Renal failure under dialysis3.620.0311.13-11.60
Prior heart failure2.030.0381.04-3.95
Immunocompromised status (medication and/or systemic disease)2.640.0201.16-5.98
Cardiopulmonary bypass total time > 180 minutes (Ref: 0-180 minutes)2.280.0261.10-4.71
IABP/Catheter based device pre- or intra-operatively4.54<0.0012.03-10.16
Intraoperative >4 RBC units transfused2.470.0471.01-6.04


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