A Cohort Study of 7900 Patients
This research was presented by Dr. Smith at the General Surgeon’s Australia Annual Scientific Meeting on Friday 8 October 2021. Gastrointestinal (GI) complications following cardiac surgery are known to lead to significant morbidity and mortality. The objective of Dr Smith’s research project was to examine the incidence of these complications and to identify the associated risk factors from patient data in the RPAH cardiothoracic surgery database. The identification of risk factors will allow for the development of a predictive model and early management algorithm.
Gastrointestinal (GI) complications following cardiac surgery have been associated with significant morbidity and mortality. The pathogenesis of GI complications in this cohort is thought to revolve around splanchnic hypoperfusion, whereby the circulatory shifts during cardiac surgery greatly affect blood supply to splanchnic organs. These complications are difficult to diagnose for a number of reasons, including the use of sedation, vasopressors and analgesia, which mask symptoms and signs. This study sought to investigate the prevalence and risk factors for the development of GI complications post cardiac surgery.
A retrospective study was performed examining the prevalence and characteristics of patients who had GI complications following cardiac surgery at our institution over a 14-year period.
7986 patients were included in the analysis. 190 patients (2.4%) developed GI complications following cardiac surgery, and 32 (16.8%) of these patients died within 30 days of operation. Patients with these complications were 6.8 times more likely to die than those without. (95%CI 4.52-10.11, p<0.0001). The most common GI complication was GI bleeding (59), while intestinal ischaemia was most commonly associated with mortality (24). Eighty patients required surgical or radiological intervention, including laparotomy (36) or endoscopy (37). The risk factors for development of GI complications included age, smoking status, perioperative use of inotropes, cardiopulmonary bypass time, and reoperation.
GI complications following cardiac surgery are uncommon; however, they are associated with high mortality and morbidity. The identification of patients at risk of these complications may provide a useful tool to reduce morbidity and mortality in this patient cohort.