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Intestinal ischemia after cardiac surgery: analysis of a large registry
Johan Nilsson1, Erika Hansson, Bodil Andersson
11Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden
Insights
Intestinal ischemia following cardiac surgery is a rare but serious complication. Key risk factors include pre-existing conditions and postoperative complications like kidney failure and cerebrovascular insult (CVI).
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Complications
Background:
- Intestinal ischemia is a rare, severe complication post-cardiac surgery with high mortality.
- Early surgical intervention is critical for patient survival.
- This study aimed to identify incidence, outcomes, and risk factors.
Purpose of the Study:
- To analyze the incidence and outcomes of intestinal ischemia after cardiac surgery.
- To identify preoperative, intraoperative, and postoperative risk factors.
- To evaluate the predictive value of the Gastrointestinal Complications Score (GICS).
Main Methods:
- Retrospective review of 18,879 cardiac surgical procedures (1996-2011).
- Analysis of patients with registered gastrointestinal complications.
- Univariate and multivariate analyses to compare patients with and without intestinal ischemia.
Main Results:
- 17 patients (0.09%) developed intestinal ischemia, with a 59% mortality rate.
- Preoperative risk factors included steroid use, peripheral vascular disease, cardiogenic shock, and NYHA class 4.
- Postoperative risk factors included elevated creatinine, prolonged ventilation, intra-aortic balloon pump use, and cerebrovascular insult (CVI).
- The GICS demonstrated superior predictive accuracy (ROC area 0.87) compared to EuroSCORE (0.74).
Conclusions:
- Intestinal ischemia is associated with poor cardiac status, steroid use, peripheral vascular disease, postoperative kidney failure, and CVI.
- The GICS is valuable for predicting intestinal ischemia post-cardiac surgery.
- Identified risk factors can aid in early diagnosis and management.
Background:
Intestinal ischemia after cardiac surgery is a rare but severe complication with a high mortality. Early surgery can be lifesaving. The aim was to analyze the incidence, outcome, and risk factors for these patients.
Methods:
A prospectively collected database with patients who underwent 18,879 cardiac surgical procedures between 1996 and 2011 was investigated. All patients with registered gastrointestinal complications were retrospectively reviewed. Univariate and multivariate analyses were performed to compare patients with and without intestinal ischemia.
Results:
Seventeen patients suffered from intestinal ischemia (0.09%), 10 of whom (59%) died. By investigating preoperative parameters independent risk factors were steroids, peripheral vascular disease, cardiogenic shock, and New York Heart Association class 4. When including pre-, per-, and postoperative parameters, only postoperative ones were significant, including elevated creatinine (> 200 μmol/L), prolonged ventilator time, need for intra-aortic balloon pump, and cerebrovascular insult (CVI). The gastrointestinal complications score (GICS) showed a ROC area of 0.87. This was superior compared with EuroSCORE (0.74), to predict intestinal ischemia.
Conclusions:
Intestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients.
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