| Determinants of gastrointestinal complications in cardiac surgery. | |
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MedLine Citation:
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PMID: 14677737 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We designed this study to define determinants of gastrointestinal complications after cardiac surgery. From January 1992 through December 2000, 11,058 patients underwent cardiac surgery on cardiopulmonary bypass at our institution. Data were prospectively collected and univariate and multivariate analyses conducted. A total of 147 gastrointestinal complications occurred in 129 patients (129/11,058; 1.2%) including gastroesophagitis (18, 12.2%), upper gastrointestinal hemorrhage (42, 28.6%), perforated peptic ulcer (7, 4.7%), cholecystitis (10, 6.8%), pancreatitis (13, 8.8%), intestinal ischemia (17, 11.5%), colitis (18, 12.2%), diverticulitis (5, 3.4%), intestinal occlusion (2, 1.1%), lower gastrointestinal hemorrhage (1, 0.7%), and mixed gastrointestinal complications (14, 9.5%). Patients with gastrointestinal complications were significantly older and had significantly higher comorbidity (unstable angina, chronic renal failure, and peripheral vascular disease), morbidity (prolonged mechanical ventilation, intraaortic balloon pumping, bleeding, acute renal failure, stroke, and infection), and mortality rates (22.5% vs 4%, P < 0.0001). They also had longer cardiopulmonary bypass times and higher valvular surgery rates. Multivariate analysis identified 6 independent predictors for gastrointestinal complications: prolonged mechanical ventilation (odds ratio [OR], 5.5), postoperative renal failure (OR, 4.2), sepsis (OR, 3.6), valve surgery (OR, 3.2), preoperative chronic renal failure (OR, 2.7), and sternal infection (OR, 2.4). Factors such as mechanical ventilation, renal failure, and sepsis are the stronger predictors for GI complications, causing splanchnic hypoperfusion, hypomotility, and hypoxia. Furthermore, excessive anticoagulation after valve replacement may lead to GI hemorrhage. Valve surgery, often requiring anticoagulation, increases bleeding. Monitoring mechanical ventilation and hemodynamic parameters, adopting early extubation and mobilization measures, preventing infections, and strictly monitoring renal function and anticoagulation may prevent catastrophic abdominal complications. |
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Authors:
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Giuseppe D'Ancona; Richard Baillot; Brigitte Poirier; Francois Dagenais; José Ignacio Saez de Ibarra; Richard Bauset; Patrick Mathieu; Daniel Doyle |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital Volume: 30 ISSN: 0730-2347 ISO Abbreviation: Tex Heart Inst J Publication Date: 2003 |
Date Detail:
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Created Date: 2003-12-17 Completed Date: 2004-04-23 Revised Date: 2013-04-18 |
Medline Journal Info:
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Nlm Unique ID: 8214622 Medline TA: Tex Heart Inst J Country: United States |
Other Details:
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Languages: eng Pagination: 280-5 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, Laval Hospital, Quebec Heart Institute, Sainte-Foy, Quebec, Canada G1V 4G5. rgea@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Surgical Procedures / adverse effects* Cardiopulmonary Bypass / adverse effects* Female Gastrointestinal Diseases / etiology* Heart Diseases / complications, surgery Humans Intraoperative Complications Male Middle Aged Multivariate Analysis Postoperative Complications Prospective Studies Respiration, Artificial / adverse effects Risk Factors |
| Comments/Corrections | |
Comment In:
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Tex Heart Inst J. 2004;31(1):108
[PMID:
15061641
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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