title: [Abdominal complications associated with cardiac surgery. Review of a contemporary surgical experience and of a series done without extracorporeal circulation].
abstract: BACKGROUND
  To evaluate the prevalence, risk factors and morbidity associated with gastrointestinal (GI) complications after cardiac surgery, with and without cardiopulmonary bypass, we carried out a retrospective cohort study at a university teaching hospital.
  
  
  METHODS
  We divided the 11,405 eligible adult patients into 2 groups: group A (operated on between January 1992 and June 1996) (4657 patients) and group B (operated on between July 1996 and December 2000) (6748 patients).
  
  
  RESULTS
  We found 147 GI complications in 134 (1.2%) patients. The incidence of GI morbidity was similar for the 2 groups of patients (group A, n = 59/4657 [1.2%]; group B, n = 75/6748 [1.1%]. Patients from group B were older, obese, diabetic and presented with more peripheral and cerebrovascular disease. Bleeding, gastritis and ulcer with perforation, the most common of these GI events, were associated with the esophagus and stomach (67/147 [45.5%]). Other events that we documented included cholecystitis 10 (6.8%), pancreatitis 13 (8.8%), episodes of small and large bowel ischemia 17 (11.6%), pseudomembranous colitis 12 (8.3%) and diverticulitis 5 (3.4%). Mesenteric ischemia was responsible for 11 (37.9%) of the 29 deaths. Two hundred and ninety-three patients were revascularized without extracorporeal circulation during this study. In this group, we were able to pinpoint 5 (1.7%) GI complications with 3 cases of mesenteric ischemia. Multivariate analysis identified renal insufficiency, prolonged intubation and sepsis as significant, predictive variables of GI complications for the 2 groups of patients whereas the Parsonnet score and stroke were predictive for the second group.
  
  
  CONCLUSIONS
  Although cardiac surgery is now being performed on older patients with significant comorbidity, we could not demonstrate a significant increase of GI complications after cardiac surgery. Off-pump coronary artery bypass does not seem to protect patients from these complications.
authors.affiliation: Département de chirurgie cardiaque, Institut universitaire de cardiologie et de pneumologie, Hôpital Laval, Ste-Foy, Québec.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Poirier
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Richard
authors.initials: R
authors.lastname: Bauset
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Serge
authors.initials: S
authors.lastname: Simard
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dionne
authors.forename: Manon
authors.initials: M
authors.lastname: Caouette
authors.forename: Frédéric-Simon
authors.initials: FS
authors.lastname: Hould
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000453:epidemiology; D004935:Esophageal Diseases / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology*; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013152:Splanchnic Circulation