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 Ratio | P-value | 95% Conf. Intervals | |
| Age | 1.03 | 0.068 | 1.00-1.06 |
| Body Mass Index | 0.94 | 0.072 | 0.88-1.01 |
| Dyslipidemia | 0.43 | 0.027 | 0.20-0.91 |
| Hypertension | 5.74 | 0.007 | 1.60-20.59 |
| Chronic lung disease | 2.61 | 0.007 | 1.30-5.23 |
| Renal failure under dialysis | 3.62 | 0.031 | 1.13-11.60 |
| Prior heart failure | 2.03 | 0.038 | 1.04-3.95 |
| Immunocompromised status (medication and/or systemic disease) | 2.64 | 0.020 | 1.16-5.98 |
| Cardiopulmonary bypass total time > 180 minutes (Ref: 0-180 minutes) | 2.28 | 0.026 | 1.10-4.71 |
| IABP/Catheter based device pre- or intra-operatively | 4.54 | <0.001 | 2.03-10.16 |
| Intraoperative >4 RBC units transfused | 2.47 | 0.047 | 1.01-6.04 |
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