Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients.
OBJECTIVE
The aim of this audit was to determine the incidence of major gastrointestinal (GI) complications associated with intraoperative transesophageal echocardiography (TEE) in adult cardiac surgical patients in this institution.


METHODS
Retrospective database audit.


METHODS
University-affiliated teaching hospital.


METHODS
Eight hundred fifty-nine consecutive cardiac surgical patients.


METHODS
None.


RESULTS
The records of all patients who developed a major upper GI complication within 30 days of cardiac surgery between January 2001 and May 2003 were examined. The patients were identified by cross-referencing cardiac surgery and endoscopy databases. A major GI complication was defined as a perforation of the esophagus or stomach or upper GI bleeding requiring transfusion, endoscopic, or surgical intervention. Early presentation was defined as <24 hours; late presentation was defined as >24 hours. During the audit period, 859 patients underwent cardiac surgery. Five hundred sixteen patients had cardiac surgery with TEE (group 1), and 343 patients had cardiac surgery without TEE (group 2). Six patients were identified, 1.2% (95% confidence interval [CI], CI, 0.5%-2.5%) in group 1 who had a major upper GI complication consistent with TEE injury. Two patients, 0.38% (95% CI, 0.05%-1.40%), presented early, and 4 patients, 0.76% (95% CI, 0.21%-1.98%), presented late. One patient in group 2 developed a major upper GI complication, 0.29% (95% CI, 0.01%-1.6%).


CONCLUSIONS
The incidence of major GI complications attributed to TEE in this group of cardiac surgical patients was higher than previously reported. Late presentation was more common than early presentation. Previous studies that have not included late presentations may have underestimated the true incidence of major GI complications related to TEE.
Lennon
Mark J
MJ
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. mjlennon1@bigpond.com
Gibbs
Neville M
NM
Weightman
William M
WM
Leber
Jacqueline
J
Ee
Hooi C
HC
Yusoff
Ian F
IF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D016208:Databases, Factual; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D004724:Endoscopy; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007422:Intestines / Q000293:injuries*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries*