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Abdominal complications following cardiac surgery
G G Tsiotos1, C J Mullany, S Zietlow
1Division of General Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Abdominal complications after cardiac surgery are rare but serious, affecting 0.6% of patients. Risk factors include older age, prior gastrointestinal issues, and low cardiac output, with intestinal ischemia having the highest mortality.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Outcomes
Background:
- Abdominal complications following cardiac surgery are infrequent but can lead to significant morbidity and mortality.
- Understanding the incidence, types, and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, and outcomes of abdominal complications in patients undergoing cardiac surgery.
- To identify risk factors associated with the development of these complications.
Main Methods:
- A retrospective study comparing 116 patients who developed abdominal complications after cardiac surgery with 217 control patients.
- Data collected included patient demographics, medical history, surgical details, postoperative complications, treatments, and mortality.
Main Results:
- The incidence of abdominal complications was 0.6% (116/19,246 patients).
- Key complications included peptic ulcer disease (47%), intestinal obstruction/perforation (16%), and mesenteric ischemia (11%).
- Risk factors identified were older age, history of alcohol abuse, previous gastrointestinal problems, reoperative valve surgery, and severe postoperative low cardiac output. Mortality was 26%, with intestinal ischemia having the highest rate (85%).
Conclusions:
- Abdominal complications, though rare, are a significant concern in cardiac surgery patients.
- Early identification of at-risk patients and prompt management are essential to reduce mortality.
Abstract:
Between 1978 and 1991, 116 of 19,246 patients (0.6%) undergoing cardiac surgery developed abdominal complications (renal/hepatic failure excluded) within 30 days of their cardiac operation. Comparison with a randomly selected control group of 217 patients operated upon over the same period of time was also undertaken. Compared to the control group, the study patients were older (mean age, 63.3 +/- 12.5 years vs 57.5 +/- 21.5 years; P = 0.03), more likely to have a history of alcohol abuse (10% vs 4%; P = 0.03), and more likely to have a previous history of gastrointestinal problems (43% vs 17%; P = 0.0001). There was also a trend towards a greater number of patients having valvular surgery, particularly reoperative surgery, in the study group. Postoperatively, patients with marked low cardiac output, requiring the intra-aortic balloon pump, were more likely to develop abdominal complications. These complications included complicated peptic ulcer disease in 54 (47%), intestinal obstruction and/or perforation in 19 (16%), biliary tract disease in 13 (11%), mesenteric ischemia in 13 (11%), acute pancreatitis in 3 (3%), and miscellaneous complications in the remaining 14 (12%). Forty-three patients were treated medically and 73 patients required operative intervention. The surgical procedures performed were truncal vagotomy and drainage (12), oversewing of a perforation or a bleeding vessel (6), gastrectomy (2), intestinal resection (14), laparotomy only (14), cholecystectomy (14), and other (11). Mortality was 26% (30/116) with the mortality for medical and surgical treatment being 16% vs 32%, respectively (P = 0.112). Intestinal ischemia had the highest mortality, with a rate of 85% (11/13). Despite intensive monitoring and care of cardiac surgical patients, abdominal complications do occur, although rarely. Risk factors include older age, a positive history of gastrointestinal disease, reoperative valve surgery, and severe postoperative low cardiac output.