title: Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.
abstract: BACKGROUND
  Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage.
  
  
  METHODS
  A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes.
  
  
  RESULTS
  Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%)
  
  
  CONCLUSIONS
  In the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population.
authors: Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA. Electronic address: ashfaq.awais@mayo.edu.
authors: Awais
authors: A
authors: Ashfaq
authors: Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA. Electronic address: Johnson.daniel1@mayo.edu.
authors: Daniel J
authors: DJ
authors: Johnson
authors: Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA. Electronic address: chapital.alyssa@mayo.edu.
authors: Alyssa B
authors: AB
authors: Chapital
authors: Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA. Electronic address: lanza.louis@mayo.edu.
authors: Louis A
authors: LA
authors: Lanza
authors: Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA. Electronic address: devaleria.patrick@mayo.edu.
authors: Patrick A
authors: PA
authors: DeValeria
authors: Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: francisco.arabia@cshs.org.
authors: Francisco A
authors: FA
authors: Arabia
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000401:mortality; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Abdominal complication; Cardiac surgery; Mechanical circulatory device; Mortality