Gastrointestinal emergencies in cardiac surgery. A retrospective analysis of 3,724 consecutive patients from a single center.
OBJECTIVE
The aim of this study is to retrospectively analyze risk factors, diagnosis and management of gastrointestinal (GI) complications following cardiac operations.


METHODS
Patients who developed GI complications after a cardiac operation were studied. Anesthesia protocols, techniques of cardiac surgery, potential risk factors, complications and medical and surgical interventions were reviewed and analyzed.


RESULTS
Out of 3,724 consecutive patients undergoing heart operations during an 8-year period, 33 patients developed GI complications. Eleven patients developed ischemic colitis, 8 cholecystitis, 6 GI bleeding, 4 liver failures, 3 pancreatitis and 1 esophageal hernia. Patients with GI complications had a lower mean ejection fraction compared to patients not developing these complications (45.1 vs. 49.7%, p < 0.01). Also, patients undergoing an urgent cardiac operation were significantly more likely (3.49 times more likely) to develop GI complications postoperatively. Of the 33 affected patients, 18 were treated conservatively and 15 underwent an emergency exploratory laparotomy. Overall mortality was 12% (4 patients).


CONCLUSIONS
Intestinal ischemia and cholecystitis appear to be the most frequent GI complications associated with cardiac surgery. Risk factors include a low ejection fraction and an urgent cardiac operation. Early recognition and treatment of these complications may reduce mortality.
Vassiliou
Ioannis
I
Department of Surgery, Aretaieio University Hospital, Athens Medical School, University of Athens, Athens, Greece. ianvass@otenet.gr
Papadakis
Emmanouel
E
Arkadopoulos
Nikolaos
N
Theodoraki
Kassiani
K
Marinis
Athanasios
A
Theodosopoulos
Theodosios
T
Palatianos
George
G
Smyrniotis
Vassilios
V
D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome