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Intestinal complications associated with cardiovascular surgical procedures
Critical Care volume 11, Article number: P252 (2007)
Intestinal complications after cardiopulmonary bypass procedures are infrequent but they carry a significant incidence of morbidity and mortality. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. The purpose of this study was to ascertain the frequency of intestinal complications following open heart surgery, to assess preoperative predisposing factors and to elucidate that prompt diagnosis and institution of therapy are the most common factors to improve the outcome.
A prospective survey was conducted among 4,588 patients undergoing cardiac surgery and attending the surgical ICU from 1 January 2002 to 31 December 2004. All case histories of patients were objected to meticulous analysis searching for complications involving gastrointestinal tract and requiring surgical consultation. Patients with minor disorders were excluded from the study. We performed a multivariable logistic regression analysis to identify the risk factors for development of postoperative intestinal complications.
Gastrointestinal complications occurred in 63 patients, while in 35 patients appeared transient episodes of gut mucosal ischemia. Sixteen patients presented mesenteric ischemia, six paralytic ileus, six colonic obstruction, two lower gastrointestinal bleeding, two upper gastrointestinal bleeding, two perforated duodenal ulcer and one rectal perforation. Intestinal complications correlated with advanced age (67.5 ± 12 years), preoperative congestive heart failure and peripheral vascular disease, prolonged bypass time (156 ± 91.7 min) and aortic cross-clump time (97.6 ± 44.45 min), the number of blood and plasma transfusions, re-exploration of the chest, the administration of inotrops (70%) and the usage of a intra-aortic balloon pump (42%). The mean EuroSCORE value was 12.72 ± 3.8. The majority of patients presented at the end of the first postoperative week. Fifteen patients died (48%).
Intestinal complications after cardiac surgery are uncommon but life-threatening and may result from ischemic mucosal injury, which increases mucosal permeability and promotes the translocation of bacterial toxins and the release of mediators. Clinical features are often subtle and a high index of suspicion is necessary for an early diagnosis and the institution of appropriate treatment.
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Mastoraki, S., Mastoraki, E., Douka, L. et al. Intestinal complications associated with cardiovascular surgical procedures. Crit Care 11, P252 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5412
- Duodenal Ulcer
- Peripheral Vascular Disease
- Mesenteric Ischemia
- Multivariable Logistic Regression Analysis
- Colonic Obstruction