Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality

Haytham Elgharably; Maysoon Gamaleldin; Kamal S. Ayyat; Anthony Zaki; Kevin Hodges; Bogdan Kindzelski; Shashank Sharma; Tarek Hassab; Camille Yongue; Solanus de la Serna; Juan Perez; Capri Spencer; Faisal G. Bakaeen; Scott R. Steele; A. Marc Gillinov; Lars G. Svensson; Gosta B. Pettersson

doi:10.1016/j.athoracsur.2020.09.034

Back

Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality

Journal article

Peer reviewed

Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality

Haytham Elgharably, Maysoon Gamaleldin, Kamal S. Ayyat, Anthony Zaki, Kevin Hodges, Bogdan Kindzelski, Shashank Sharma, Tarek Hassab, Camille Yongue, Solanus de la Serna, …

The Annals of thoracic surgery, Vol.112(4), pp.1266-1274

10/01/2021

DOI: 10.1016/j.athoracsur.2020.09.034

PMID: 33217398

View Online

Abstract

Severe gastrointestinal (GI) complications (GICs) after cardiac surgery are associated with poor outcomes. Herein, we characterize the severe forms of GICs and associated risk factors of mortality. We retrospectively analyzed the clinically significant postoperative GICs after cardiac surgical procedures performed at our institution from January 2010 to April 2017. Multivariable analysis was used to identify predictors for in-hospital mortality. Of 29,909 cardiac surgical procedures, GICs occurred in 1037 patients (3.5% incidence), with overall in-hospital mortality of 14% compared with 1.6% in those without GICs. GICs were encountered in older patients with multiple comorbidities who underwent complex prolonged procedures. The most lethal GICs were mesenteric ischemia (n = 104), hepatopancreatobiliary (HPB) dysfunction (n = 139), and GI bleeding (n = 259), with mortality rates of 45%, 27%, and 17%, respectively. In the mesenteric ischemia subset, coronary artery disease (odds ratio [OR], 4.57; P = .002], coronary bypass grafting (OR, 6.50; P = .005), reoperation for bleeding/tamponade (OR, 12.07; P = .01), and vasopressin use (OR, 11.27; P < .001) were predictors of in-hospital mortality. In the HPB complications subset, hepatic complications occurred in 101 patients (73%), pancreatitis in 38 (27%), and biliary disease in 31 (22%). GI bleeding occurred in 20 patients (31%) with HPB dysfunction. In the GI bleeding subset, HPB disease (OR, 10.99; P < .001) and bivalirudin therapy (OR, 12.84; P = .01) were predictors for in-hospital mortality. Although relatively uncommon, severe forms of GICs are associated with high mortality. Early recognition and aggressive treatment are mandatory to improve outcomes. [Display omitted]

Details

Title: Subtitle: Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality
Creators: Haytham Elgharably - Cleveland Clinic
Maysoon Gamaleldin - Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
Kamal S. Ayyat - Cleveland Clinic
Anthony Zaki - Cleveland Clinic
Kevin Hodges - Cleveland Clinic
Bogdan Kindzelski - Cleveland Clinic
Shashank Sharma - Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
Tarek Hassab - Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
Camille Yongue - Cleveland Clinic
Solanus de la Serna - Cleveland Clinic
Juan Perez - Cleveland Clinic
Capri Spencer - Cleveland Clinic
Faisal G. Bakaeen - Cleveland Clinic
Scott R. Steele - Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
A. Marc Gillinov - Cleveland Clinic
Lars G. Svensson - Cleveland Clinic
Gosta B. Pettersson - Cleveland Clinic
Resource Type: Journal article
Publication Details: The Annals of thoracic surgery, Vol.112(4), pp.1266-1274
DOI: 10.1016/j.athoracsur.2020.09.034
PMID: 33217398
NLM abbreviation: Ann Thorac Surg
ISSN: 0003-4975
eISSN: 1552-6259
Publisher: Elsevier Inc
Number of pages: 9
Language: English
Date published: 10/01/2021
Academic Unit: Surgery
Record Identifier: 9984966749902771

Metrics

2 Record Views

See more details