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Incidence of gastrointestinal complications in cardiopulmonary bypass patients

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Abstract

Gastrointestinal complications after cardiac surgery are associated with a high mortality rate. Because of the absence of early specific clinical signs, diagnosis is often delayed. The present study seeks to determine predictive risk factors for subsequent gastrointestinal complications after cardiosurgical procedures. Within a 1-year period, a total of 1116 patients who had undergone open heart surgery with cardiopulmonary bypass were prospectively studied for gastrointestinal complications. To determine predictive factors, all case histories of the patients were analyzed. Of the 1116 patients, 23 (2.1%) had gastrointestinal complications during the postoperative period, 10 of whom had to undergo subsequent abdominal surgery. Of these 23 patients, 20 died. Early gastrointestinal complications, which occurred mostly on postoperative days 6 or 7, consisted of bowel ischemia or hepatic failure. Late complications were gastrointestinal bleeding, pseudomembranous colitis, cholecystitis, and septic rupture of a spleen. The relative risk for abdominal complications after cardiopulmonary bypass was highly increased in association with (1) a cardiac index less than 2.0 l/min−1/(m2)−1, (2) postoperative onset of atrial fibrillation, (3) emergency surgery, (4) need for vasopressors, (5) need for intraaortic balloon counterpulsation, and (6) need for early redo thoracotomy due to surgical complications. All patients with necrotic bowel disease had elevated serum lactate levels. Furthermore, cardiopulmonary bypass and aortic clamping times were significantly prolonged in patients who developed gastrointestinal complications. A number of predictive factors contribute to the development of gastrointestinal complications after cardiopulmonary bypass surgery. Knowledge of these factors may lead to earlier identification of patients at increased risk and may allow more efficient and earlier interventions to reduce mortality.

Résumé

Objectifs: Les complications gastro-intestinales après chirurgie cardiaque sont associéesà un taux de mortalité élevé. Le diagnostic en est souvent retardé en raison de I’absence de signes cliniques spécifiques, précoces. Cette étude chercheà déterminer les facteurs de risque prédictifs de complications gastrointestinales après chirurgie cardio-vasculaire. Méthodes: Pendant une période d’un an, 1116 patients au total ayant eu une intervention chirurgicaleà coeur ouvert avec shunt cardiopulmonaire ont été étudiés prospectivement dans` la recherche de complications gas tro-intestinales. Afin de déterminer les facteurs prédictifs, tous les antécédents ont é té analysés. Résultats: 23 (2.1%) des 1116 patients ont eu des complications gastrointestinales pendant la période postopératoire, dont 10 qui ont nécessité un acte chirurgical abdominal. Parmi ces 23 patients, 20 sont décédés. Des complications gastro-intestinales précoces sont survenues aux jours postopératoires 6 ou 7, sous forme d’ischémie intestinale ou d’insuffisance hepatique. Les complications tardives ont été I’hémorragie gastro-intestinale, la colite pseudomembraneuse, la cholécystite et un cas de rupture septique de la rate. Le risque relatif de faire des complications abdominales après shunt cardio-pulmonaire était plus important lorsque le patient: (1) avait un indexe cardiaque inférieurà 2,0 l/min−1/ (m2)−1, (2) a prése nté une fibrillation auriculaire postopératoire, (3) a eu besoin d’une intervention en urgence, (4) a eu besoin de vasopresseurs, (5) a nécessité I’utilisation d’un ballonnetà contrepression, et (6) a eu une re-thoracotomie précoce en raison des complications. Tous les patients ayant une nécrose intestinale avaient des taux de lactates élevés dans le sérum. Les temps de shunt cardio-pulmonaire et de clampage aortique ont été prolongés de façon significative chez les patients qui ont développé des complications gastro-intestinales. Conclusions: II existe un certain nombre de facteurs prédictifs qui peuvent contribuer au développement des complications gastrointestinales après un shunt cardio-pulmonaire. La connaissance de ces facteurs pourrait aiderà identifier ces patientsà risque et pourrait permettre une intervention plus efficace et plus précoce, réduisant ainsi la mortalité.

Resumen

Objetivo: Las complicaciones gastrointestinales tras cirugía cardiaca conllevan una alta tasa de mortalidad. Debido a la ausencia de signos clinico precoces, el diagnóstico, con frecuenci à, se retrasa. El presente estudio pretende averiguar los factores que permitan predecir el riesgo de padecer complicaciones gastrointestinales tras cirugía cardiaca. Métodos: Durante un anõ se estudiaron prospectivamente las complicaciones gastrointestinales de 1,116 pacientes intervenidos a corazón abierto con derivación cardio-pulmonar. Se analizaron las historias clínicas de todos los pacientes con objeto de averiguar los factores predictivos. Resultados: En 23 (2.1%) de los 1,116 pacientes se produjeron complicaciones gastrointestinales en el periodo postoperatorio, requiriendo 10 de ellos tratamiento quirúrgico. De los 23 pacientes, 20 fallecieron. Las complicaciones gastrointestinales precoces aparecieron entre el 6, 7 dias del postoperatorio, tratándose de isquemia intestinal o fracaso hepático. Las complicaciones tardias fueron: hemorragia gastrointestinal, colitis pseudo-membranosa, colecistitis y ruptura séptica del bazo. El riesgo de desarrollar complicaciones abdominales, tras derivación cardio-pulmonar se incrementa cuando se producen: (1) índice cardiaco menor a 2.0 l/min−1/ (m2)−1, (2) crisis postoperatorias de fibrilación atrial, (3) cirug ía de urgencia, (4) utilización de vasopresores, (5) empleo del balón intraaórtico de contrapulsación y (6) retoracotomía precoz por complicaciones quirúrgicas. Todos los pacientes con afectación necrótica intestinal presentaron niveles altos de la concentración sérica de lactato. Además, en los pacientes que desarrollaron complicaciones gastrointestinales, tanto el tiempo de derivación cardio-pulmonar como el del clampado de aorta fueron significativamente más prolongados. Conclusiones: Se describen diversos factores predictivos que contribuyen al desarrollo de complicaciones gastrointestinales tras cirugía cardiaca con derivación cardio-pulmonar. El conocimiento de los mismos, permitirá la identificación precoz de los pacientes de mayor riesgo, pudiéndose así realizar intervenciones más precoces y eficaces que reduzcan la mortalidad.

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Authors and Affiliations

  1. Department of Anesthesiology, Intensive Care Medicine, and Pain Control, J. W. Goethe-University Hospital Center, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany

    Christian Byhahn M.D., Ulrich Strouhal M.D., Paul Kessler MD, Ph.D. & Klaus Westphal M.D., Ph.D.

  2. Department of Thoracic and Cardiovascular Surgery, J.W. Goethe-University Hospital Center, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany

    Sven Martens M.D. & Stephan Mierdl M.D.

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  1. Christian Byhahn M.D.
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  2. Ulrich Strouhal M.D.
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  3. Sven Martens M.D.
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  4. Stephan Mierdl M.D.
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  5. Paul Kessler MD, Ph.D.
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  6. Klaus Westphal M.D., Ph.D.
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Correspondence to Christian Byhahn M.D..

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Byhahn, C., Strouhal, U., Martens, S. et al. Incidence of gastrointestinal complications in cardiopulmonary bypass patients. World J. Surg. 25, 1140–1144 (2001). https://doi.org/10.1007/BF03215861

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