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Risk Factors Associated with In-Hospital Mortality for Patients with Acute Abdomen After Cardiac Surgery

  • I. DjordjevicEmail author
  • K. Eghbalzadeh
  • S. Heinen
  • G. Schlachtenberger
  • S. Gerfer
  • A. Sabashnikov
  • J. Merkle
  • C. Weber
  • E. Kuhn
  • M. Zeriouh
  • P. Rahmanian
  • N. Mader
  • O.-J. Liakopoulos
  • T. Wahlers
Original Scientific Report
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Abstract

Objectives

Management of acute abdomen (AA) differs due to the heterogeneity of underlying pathophysiology. Complications of AA and its overall outcome after cardiac surgery are known to be associated with poor results. The aim of this retrospective analysis was to evaluate risk factors for AA in patients undergoing cardiac surgery.

Methods

Between December 2011 and December 2014, a total of 131 patients with AA after cardiac surgery were identified and retrospectively analyzed using our institutional database. Statistical analysis of risk factors concerning in-hospital mortality of mentioned patient cohort was performed using IBM SPSS Statistics.

Results

Overall in-hospital mortality was 54.2% (71/131). Analyzing in-hospital non-survivors (NS) versus in-hospital survivors (S) peripheral artery disease (28.2% vs. 11.7%; p = 0.03), the need for assist device therapy (33.8% vs. 16.7%; p = 0.03) and the requirement of hemodialysis (67.6% vs. 23.3%; p < 0.01) were significantly higher in NS. Furthermore, lactic acid values at onset of symptoms were shown to be significantly higher in NS (5.7 ± 5.7 mmol/L vs. 2.8 ± 2.9 mmol/L; p < 0.01). Assured diagnosis of mesenterial ischemia was strongly associated with worse outcome (odds ratio 10.800, 95% confidence interval 2.003–58.224; p = 0.006).

Conclusion

In conclusion, in critically ill patients after performed cardiac surgery peripheral vascular disease, need for supportive hemodynamic assist device systems and occurrence of renal failure are risk factors associated with worsen outcome. Additionally, rise of lactic acid could potentially be associated with onset of intestinal malperfusion and should be taken into account in therapeutic decisions preventing fatal mesenterial ischemia.

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Viana FF, Chen Y, Almeida AA, Baxter HD, Cochrane AD, Smith JA (2013) Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J Surg 83:651–656CrossRefGoogle Scholar
  2. 2.
    Hecker A, Hecker B, Kipfmuller K, Holler J, Schneck E, Reichert M et al. Diagnosis and therapy of an acute abdomen. Med Klin Intensivmed Notfmed 2014;109:445–56; quiz 57–8.Google Scholar
  3. 3.
    Mayumi T, Yoshida M, Tazuma S, Furukawa A, Nishii O, Shigematsu K et al (2016) Practice guidelines for primary care of acute abdomen 2015. J Hepatobiliary Pancreat Sci 23:3–36CrossRefGoogle Scholar
  4. 4.
    Chaudhry R, Zaki J, Wegner R, Pednekar G, Tse A, Sheinbaum R et al (2017) Gastrointestinal complications after cardiac surgery: a nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth 31:1268–1274CrossRefGoogle Scholar
  5. 5.
    Luther B, Mamopoulos A, Lehmann C, Klar E (2018) The ongoing challenge of acute mesenteric ischemia. Visc Med 34:217–223CrossRefGoogle Scholar
  6. 6.
    Rodriguez F, Nguyen TC, Galanko JA, Morton J (2007) Gastrointestinal complications after coronary artery bypass grafting: a national study of morbidity and mortality predictors. J Am Coll Surg 205:741–747CrossRefGoogle Scholar
  7. 7.
    Lorusso R, Mariscalco G, Vizzardi E, Bonadei I, Renzulli A, Gelsomino S (2014) Acute bowel ischemia after heart operations. Ann Thorac Surg 97:2219–2227CrossRefGoogle Scholar
  8. 8.
    Yap KH, Chua KC, Lim SL, Sin YK (2014) Is it possible to predict the risk of ischaemic bowel after cardiac surgery? Interact Cardiovasc Thorac Surg 19:494–498CrossRefGoogle Scholar
  9. 9.
    Ott MJ, Buchman TG, Baumgartner WA (1995) Postoperative abdominal complications in cardiopulmonary bypass patients: a case-controlled study. Ann Thorac Surg 59:1210–1213CrossRefGoogle Scholar
  10. 10.
    Welling RE, Rath R, Albers JE, Glaser RS (1986) Gastrointestinal complications after cardiac surgery. Arch Surg 121:1178–1180CrossRefGoogle Scholar
  11. 11.
    Huddy SP, Joyce WP, Pepper JR (1991) Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery. Br J Surg 78:293–296CrossRefGoogle Scholar
  12. 12.
    Yilmaz AT, Arslan M, Demirkilc U, Ozal E, Kuralay E, Bingol H et al (1996) Gastrointestinal complications after cardiac surgery. Eur J Cardiothorac Surg 10:763–767CrossRefGoogle Scholar
  13. 13.
    Pang PY, Sin YK, Lim CH, Su JW, Chua YL (2012) Outcome and survival analysis of intestinal ischaemia following cardiac surgery. Interact Cardiovasc Thorac Surg 15:215–218CrossRefGoogle Scholar
  14. 14.
    Tofukuji M, Stahl GL, Metais C, Tomita M, Agah A, Bianchi C et al (2000) Mesenteric dysfunction after cardiopulmonary bypass: role of complement C5a. Ann Thorac Surg 69:799–807CrossRefGoogle Scholar
  15. 15.
    Nilsson J, Hansson E, Andersson B (2013) Intestinal ischemia after cardiac surgery: analysis of a large registry. J Cardiothorac Surg 8:156CrossRefGoogle Scholar
  16. 16.
    Haglund U, Hulten L, Ahren C, Lundgren O (1975) Mucosal lesions in the human small intestine in shock. Gut 16:979–984CrossRefGoogle Scholar
  17. 17.
    Christenson JT, Schmuziger M, Maurice J, Simonet F, Velebit V (1994) Gastrointestinal complications after coronary artery bypass grafting. J Thorac Cardiovasc Surg 108:899–906PubMedGoogle Scholar
  18. 18.
    Zacharias A, Schwann TA, Parenteau GL, Riordan CJ, Durham SJ, Engoren M et al (2000) Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 27:93–99PubMedPubMedCentralGoogle Scholar
  19. 19.
    D'Ancona G, Baillot R, Poirier B, Dagenais F, de Ibarra JI, Bauset R et al (2003) Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 30:280–285PubMedPubMedCentralGoogle Scholar
  20. 20.
    Spotnitz WD, Sanders RP, Hanks JB, Nolan SP, Tribble CG, Bergin JD et al. General surgical complications can be predicted after cardiopulmonary bypass. Ann Surg 1995;221:489–96; discussion 96–7.Google Scholar
  21. 21.
    Bronicki RA, Hall M (2016) Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Pediatr Crit Care Med 17:S272–S278CrossRefGoogle Scholar
  22. 22.
    Shaefi S, Mittel A, Klick J, Evans A, Ivascu NS, Gutsche J et al (2018) Vasoplegia after cardiovascular procedures-pathophysiology and targeted therapy. J Cardiothorac Vasc Anesth 32:1013–1022CrossRefGoogle Scholar
  23. 23.
    McSweeney ME, Garwood S, Levin J, Marino MR, Wang SX, Kardatzke D et al. Adverse gastrointestinal complications after cardiopulmonary bypass: can outcome be predicted from preoperative risk factors? Anesth Analg 2004;98:1610–7, table of contents.Google Scholar
  24. 24.
    Moneta GL, Misbach GA, Ivey TD (1985) Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery. Am J Surg 149:648–650CrossRefGoogle Scholar
  25. 25.
    Sanisoglu I, Guden M, Bayramoglu Z, Sagbas E, Dibekoglu C, Sanisoglu SY et al (2004) Does off-pump CABG reduce gastrointestinal complications? Ann Thorac Surg 77:619–625CrossRefGoogle Scholar
  26. 26.
    Soylu L, Aydin OU, Yildiz M, Serdaroglu H, Kurtoglu M, Karademir S (2019) Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery. Turk J Med Sci 49:11–15CrossRefGoogle Scholar
  27. 27.
    Rastan AJ, Tillmann E, Subramanian S, Lehmkuhl L, Funkat AK, Leontyev S et al (2010) Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 122:S92–S99CrossRefGoogle Scholar
  28. 28.
    Berg D, Lebovics E, Kai M, Spielvogel D (2018) The predicament of gastrointestinal bleeding in patients with a continuous flow left ventricular assist device: pathophysiology, evaluation and management. Cardiol Rev 27:222–229CrossRefGoogle Scholar
  29. 29.
    Badenes R, Lozano A, Belda FJ (2015) Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract 2015:420513PubMedPubMedCentralGoogle Scholar
  30. 30.
    Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157:294–323CrossRefGoogle Scholar
  31. 31.
    Rahmanian PB, Kwiecien G, Langebartels G, Madershahian N, Wittwer T, Wahlers T (2011) Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients. Eur J Cardiothorac Surg 40:701–707PubMedGoogle Scholar
  32. 32.
    Pakula AM, Skinner RA (2016) Acute kidney injury in the critically ill patient: a current review of the literature. J Intensive Care Med 31:319–324CrossRefGoogle Scholar
  33. 33.
    Maxwell RA, Bell CM (2017) Acute kidney injury in the critically ill. Surg Clin North Am 97:1399–1418CrossRefGoogle Scholar
  34. 34.
    Bomberg H, Groesdonk HV, Raffel M, Minko P, Schmied W, Klingele M et al (2016) Vasopressin as therapy during nonocclusive mesenteric ischemia. Ann Thorac Surg 102:813–819CrossRefGoogle Scholar
  35. 35.
    Bomberg H, Bierbach B, Flache S, Novak M, Bandner-Risch D, Menger MD et al (2015) Vasopressin aggravates cardiopulmonary bypass-induced gastric mucosal ischemia. Eur Surg Res 54:75–86CrossRefGoogle Scholar
  36. 36.
    Bomberg H, Bierbach B, Flache S, Scheuer C, Novak M, Schafers HJ et al (2014) Vasopressin induces rectosigmoidal mucosal ischemia during cardiopulmonary bypass. J Card Surg 29:108–115CrossRefGoogle Scholar
  37. 37.
    Verma I, Kaur S, Goyal S, Goyal S, Multani JS, Narang AP (2014) Diagnostic value of lactate levels in acute abdomen disorders. Indian J Clin Biochem 29:382–385CrossRefGoogle Scholar
  38. 38.
    Shi H, Wu B, Wan J, Liu W, Su B (2015) The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia. Clin Res Hepatol Gastroenterol 39:373–378CrossRefGoogle Scholar
  39. 39.
    Ravishankaran P, Shah AM, Bhat R (2011) Correlation of interleukin-6, serum lactate, and C-reactive protein to inflammation, complication, and outcome during the surgical course of patients with acute abdomen. J Interferon Cytokine Res 31:685–690CrossRefGoogle Scholar
  40. 40.
    Hong J, Gilder E, Blenkiron C, Jiang Y, Evennett NJ, Petrov MS et al (2017) Nonocclusive mesenteric infarction after cardiac surgery: potential biomarkers. J Surg Res 211:21–29CrossRefGoogle Scholar
  41. 41.
    Ruokonen E, Takala J, Kari A (1993) Regional blood flow and oxygen transport in patients with the low cardiac output syndrome after cardiac surgery. Crit Care Med 21:1304–1311CrossRefGoogle Scholar
  42. 42.
    Abboud B, Daher R, Boujaoude J (2008) Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol 14:5361–5370CrossRefGoogle Scholar
  43. 43.
    Deng QW, Tan WC, Zhao BC, Deng WT, Xu M, Liu WF et al (2017) Risk factors for postoperative acute mesenteric ischemia among adult patients undergoing cardiac surgery: A systematic review and meta-analysis. J Crit Care 42:294–303CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • I. Djordjevic
    • 1
    Email author
  • K. Eghbalzadeh
    • 1
  • S. Heinen
    • 2
  • G. Schlachtenberger
    • 1
  • S. Gerfer
    • 1
  • A. Sabashnikov
    • 1
  • J. Merkle
    • 1
  • C. Weber
    • 1
  • E. Kuhn
    • 1
  • M. Zeriouh
    • 1
  • P. Rahmanian
    • 1
  • N. Mader
    • 1
  • O.-J. Liakopoulos
    • 1
  • T. Wahlers
    • 1
  1. 1.Department of Cardiothoracic SurgeryUniversity Hospital CologneCologneGermany
  2. 2.Department of Cardiac SurgeryINCCI Heart CentreLuxembourgLuxembourg

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