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Gastrointestinal Complications After Cardiac Surgery: Highly Morbid but Improving Over Time

Nathan Haywood1, J Hunter Mehaffey1, Robert B Hawkins1

  • 1Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.

The Journal of Surgical Research
|June 7, 2020
PubMed

Insights

Gastrointestinal complications after cardiac surgery remain common but are not increasing. While associated with high morbidity and costs, improved quality efforts have led to better long-term survival for these patients.

Area of Science:

  • Cardiovascular Surgery
  • Gastroenterology
  • Surgical Outcomes
  • Health Services Research

Background:

  • Gastrointestinal (GI) complications following cardiac surgery present significant challenges, contributing to elevated morbidity and mortality rates.
  • Understanding the specific impact of individual GI complications is crucial for improving patient outcomes.
  • Contemporary data on these complications and their associated costs are essential for evidence-based practice.

Purpose of the Study:

  • To analyze the granular impact of various gastrointestinal complications after cardiac surgery.
  • To assess the trends and outcomes of these complications over two distinct time periods.
  • To evaluate the association of GI complications with morbidity, mortality, length of stay, and long-term survival.

Main Methods:

  • A cohort of 6070 patients undergoing cardiac surgery between 2010 and 2017 was identified from an institutional database.
  • Patient records were linked with institutional data on gastrointestinal complications and associated costs.
  • Patients were divided into early (2010-2013) and current (2014-2017) eras for comparative analysis.

Main Results:

  • Gastrointestinal complications occurred in 4.6% of patients, with Clostridium difficile infection and gastrointestinal bleeding being the most frequent.
  • These complications were significantly linked to higher rates of major postoperative morbidity, mortality, prolonged hospital stays, and discharge to extended care facilities.
  • Despite no change in complication incidence between eras, long-term survival improved in the current era, with adjusted costs remaining higher for affected patients.

Conclusions:

  • The incidence of gastrointestinal complications after cardiac surgery has remained stable over time.
  • While these complications continue to be associated with substantial resource utilization and morbidity, significant improvements in long-term survival have been observed.
  • These improved outcomes underscore the positive impact of quality improvement initiatives in managing patients with GI complications post-cardiac surgery.
Abstract

Keywords:
Cardiac surgeryGastrointestinal complicationPostoperative complicationResource utilizationSurvival

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