Document Detail


Predictors of gastrointestinal complications in cardiac surgery.
MedLine Citation:
PMID:  10928493     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Gastrointestinal problems are infrequent but serious complications of cardiac surgery, with high rates of morbidity and mortality. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. In a retrospective review of our cardiac surgery experience from July 1991 through December 1997 we found that postoperative gastrointestinal complications were diagnosed in 86 of 4,463 consecutive patients (1.9%). We categorized these 86 patients into 2 groups--Surgical and Medical--according to the method of treatment used for their complications. In the Medical group, 9 of 52 patients (17%) died; in the Surgical group, 17 of 34 (50%) died. By logistic multivariate analysis, we identified 8 parameters that predicted gastrointestinal complications: age greater than 70 years, duration of cardiopulmonary bypass, need for blood transfusions, reoperation, triple-vessel disease, New York Heart Association functional class IV, peripheral vascular disease, and congestive heart failure. Postoperative re-exploration for bleeding was a predictor specific to the Surgical group. Use of an intraaortic balloon pump was markedly higher in the Gastrointestinal group than in the Control group (30% vs 10%, respectively), as was the use of inotropic support in the immediate postoperative period (27% vs 5.6%). Our results suggest that intra-abdominal ischemic injury is a likely contributing factor in most gastrointestinal complications. In turn, the ischemia is probably caused by hypoperfusion due to low cardiac output, hypotension due to blood loss, and intra-abdominal atheroemboli. The derived models are useful for identifying patients whose risk of gastrointestinal complications after cardiac surgery may be reduced by clinical measures designed to counter these mechanisms.
Authors:
A Zacharias; T A Schwann; G L Parenteau; C J Riordan; S J Durham; M Engoren; N Fenn-Buderer; R H Habib
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  27     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2000  
Date Detail:
Created Date:  2000-12-07     Completed Date:  2000-12-07     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  93-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdomen / blood supply
Cardiac Surgical Procedures*
Case-Control Studies
Gastrointestinal Diseases / epidemiology,  etiology*
Humans
Incidence
Ischemia / etiology
Logistic Models
Multivariate Analysis
Postoperative Complications / epidemiology,  etiology*
Retrospective Studies
Risk Factors
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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