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Gastrointestinal complications following cardiac surgery: A national analysis
Zihan Gao1, Troy N Coaston1, Konmal Ali1
1Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA.
Insights
Gastrointestinal complications after cardiac surgery increase mortality and costs. High-volume hospitals may reduce these risks, highlighting the need for better prevention and management strategies.
Area of Science:
- Cardiology
- Gastroenterology
- Health Services Research
Background:
- Gastrointestinal complications affect approximately 1 in 20 patients undergoing cardiac surgery.
- These complications are linked to adverse outcomes, but recent data are limited.
Purpose of the Study:
- To analyze the incidence and impact of gastrointestinal complications following cardiac surgery.
- To investigate the association between hospital volume and these complications.
Main Methods:
- Analysis of Nationwide Readmission Database data from 2016-2021 for elective adult cardiac surgery.
- Stratification of hospitals into high-volume and lower-volume centers.
- Multivariable regression to assess the relationship between gastrointestinal complications and outcomes.
Main Results:
- Gastrointestinal complications occurred in 4.2% of 650,667 patients, with incidence increasing over time.
- Patients with these complications had higher in-hospital mortality, longer stays, and increased costs.
- High-volume hospitals were associated with reduced odds of gastrointestinal complications and failure to rescue.
Conclusions:
- Gastrointestinal complications are independently linked to worse outcomes after cardiac surgery.
- A significant volume-outcome relationship exists, suggesting hospital volume impacts complication rates.
- Further research is crucial for understanding and mitigating gastrointestinal complications in cardiac surgery patients.
Background:
Gastrointestinal complications occur in ∼1 of 20 patients undergoing cardiac surgery and are associated with adverse consequences, although contemporary analyses are lacking.
Methods:
All elective adult (≥18) hospitalizations entailing coronary artery bypass grafting, valve procedures, or a combination thereof were identified in the 2016-2021 Nationwide Readmission Database. Institutions were stratified by annual hospital cardiac surgery volume, with the highest quartile defined as high-volume hospitals. Outcomes included in-hospital mortality, perioperative complications, failure to rescue, length of stay, and inpatient costs. Multivariable regression models were used to evaluate the association of gastrointestinal complications with outcomes of interest.
Results:
Of an estimated 650,667 patients, 27,023 (4.2%) developed gastrointestinal complications. The incidence of gastrointestinal complications increased from 3.5% to 4.6% (nptrend < .001), whereas failure to rescue declined from 17.6% to 14.8% over the study period (nptrend < .001). Compared with others, patients with gastrointestinal complications were older (69 vs 67 years, P < .001) and less commonly female (25.4 vs 29.3%, P < .001). Furthermore, those with gastrointestinal complications had increased odds of in-hospital mortality (adjusted odds ratio 3.88, 95% confidence interval 3.56-4.23), 90-day length of stay (β +2.14, 95% confidence interval 0.54-3.75), and 90-day inpatient costs (β +$8,400, 95% confidence interval 7800-8,900). Care at high-volume hospitals was associated with reduced odds of gastrointestinal complications (adjusted odds ratio 0.91, 95% confidence interval 0.86-0.97) and failure to rescue (adjusted odds ratio 0.93, 95% confidence interval 0.89-0.98).
Conclusion:
Gastrointestinal complications following cardiac surgery is independently associated with inferior outcomes, and a volume-outcome relationship was identified. Continued research efforts are warranted to understand mechanisms and risks to prevent and manage gastrointestinal complications.
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