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Fecal Occult Blood Screening before Cardiac Surgery
Yoshiyuki Takami1, Atsuo Maekawa1, Koji Yamana1
1Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
The Thoracic and Cardiovascular Surgeon
|March 13, 2023
Summary
Preoperative fecal immunochemical testing (FIT) before cardiac surgery may not effectively identify gastrointestinal bleeding but can detect malignant lesions. This screening may influence surgical decisions and patient management.
Area of Science:
- Cardiology
- Gastroenterology
- Oncology
Background:
- Increasing gastrointestinal (GI) bleeding concerns post-cardiac surgery due to antiplatelet and anticoagulant use.
- Need to evaluate preoperative screening methods for GI bleeding and cancer.
Purpose of the Study:
- To investigate the role of preoperative fecal occult blood screening using fecal immunochemical test (FIT) in patients undergoing cardiac surgery.
- To assess the impact of FIT on identifying GI bleeding and malignant lesions.
Main Methods:
- Retrospective review of 1,663 patients undergoing FIT before cardiac surgery (2012-2020).
- FIT performed 2-3 weeks preoperatively without suspending antiplatelet/anticoagulant therapy.
- Analysis of positive FIT results, subsequent endoscopy findings, and postoperative GI events.
Main Results:
- 13.7% of patients had positive FIT; risk factors included age >70, anticoagulants, and chronic kidney disease.
- Endoscopy in FIT-positive patients revealed no bleeding sites but detected early gastric cancer (2 patients) and colorectal cancer (5 patients).
- Postoperative GI events occurred in 15.6% of FIT-positive patients vs. 1.5% of FIT-negative patients.
Conclusions:
- Preoperative FIT has limited utility in identifying GI bleeding sites in cardiac surgery patients, partly due to anticoagulant influence.
- FIT may aid in detecting GI malignant lesions, potentially impacting surgical risk assessment and management strategies.
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