title: Elective versus emergency abdominal surgery following cardiac transplantation: a Victorian state transplant service experience.
abstract: BACKGROUND
  Heart transplant patients constitute a unique patient cohort with multiple risk factors predictive of poor surgical outcome. The Alfred Hospital offers the only heart transplant service in Victoria, Australia. This article presents The Alfred Hospital's experience with outcomes of abdominal operations in the heart transplant patient population.
  
  
  METHODS
  The statewide cardiothoracic registry was cross-referenced with The Alfred Hospital's electronic hospital database to identify heart transplant patients who had undergone abdominal surgery from 2002 to November 2012. Patients who met the inclusion criteria were evaluated in two groups: elective and emergency surgical settings. In the emergency group, risk factors recorded for poor surgical outcome were high-dose immunosuppression therapy, diabetes and other conventional vascular risk factors. Outcome measures assessed in both groups were length of stay, readmission within 30 days and 1-year mortality.
  
  
  RESULTS
  Twelve patients were identified who underwent 13 abdominal operations. Eight were elective cases and five were emergent abdominal operations. The mean length of stay was shorter in the elective group than the emergency group (2.5 days versus 21.3 days). There was one readmission within 30 days, and no mortality at 1 year following elective surgery. In the emergency surgery group, two patients were readmitted within 30 days post-operatively, and there were two deaths observed in this group.
  
  
  CONCLUSIONS
  The Alfred Hospital experience demonstrates that elective abdominal surgery following heart transplantation can be performed safely. Emergent surgery in this group of patients, however, is associated with poorer outcomes.
authors.affiliation: Department of Colorectal Surgery, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Kras
authors.forename: Shaun W
authors.initials: SW
authors.lastname: Yo
authors.forename: Silvana F
authors.initials: SF
authors.lastname: Marasco
authors.forename: Roger
authors.initials: R
authors.lastname: Wale
authors.forename: Satish K
authors.initials: SK
authors.lastname: Warrier
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D016027:Heart Transplantation; D046449:Hernia, Abdominal / Q000601:surgery*; D006552:Hernia, Inguinal; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D012307:Risk Factors; D014739:Victoria; D055815:Young Adult
keywords: abdominal surgery; heart transplant