Gastrointestinal complications following on-pump cardiac surgery-A propensity matched analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
07
02
2019
accepted:
20
05
2019
entrez:
6
6
2019
pubmed:
6
6
2019
medline:
12
2
2020
Statut:
epublish
Résumé
Gastrointestinal complications following on-pump cardiac surgery are orphan but serious risk factors for postoperative morbidity and mortality. We aimed to assess incidence, perioperative risk factors, treatment modalities and outcomes. A university medical center audit comprised 4883 consecutive patients (median age 69 [interquartile range IQR 60-76] years, 33% female, median logistic EuroScore 5 [IQR 3-11]) undergoing all types of cardiac surgery including surgery on the thoracic aorta; patients undergoing repair of congenital heart disease, implantation of assist devices or cardiac transplantation were excluded. Coronary artery disease was the leading indication for on-pump cardiac surgery (60%), patients undergoing cardiac surgery under urgency or emergency setting were included in analysis. We identified a total of 142 patients with gastrointestinal complications. To identify intra- and postoperative predictors for gastrointestinal complications, we applied a 1:1 propensity score matching procedure based on a logistic regression model. Overall, 30-day mortality for the entire cohort was 5.4%; the incidence of gastrointestinal complications was 2.9% and median time to complication 8 days (IQR 4-12). Acute pancreatitis (n = 41), paralytic ileus (n = 14) and acute cholecystitis (n = 18) were the leading pathologies. Mesenteric ischemia and gastrointestinal bleeding accounted for 16 vs. 18 cases, respectively. While 72 patients (51%) could be managed conservatively, 27 patients required endoscopic/radiological (19%) or surgical intervention (43/142 patients, 30%); overall 30-day mortality was 12.1% (p<0.001). Propensity score matching identified prolonged skin-to-skin times (p = 0.026; Odds Ratio OR 1.003, 95% Confidence Interval CI 1.000-1.007) and extended on-pump periods (p = 0.010; OR 1.006, 95%CI 1.001-1.011) as significant perioperative risk factors. Prolonged skin-to-skin times and extended on-pump periods are important perioperative risk factors regardless of preoperative risk factors.
Sections du résumé
BACKGROUND
Gastrointestinal complications following on-pump cardiac surgery are orphan but serious risk factors for postoperative morbidity and mortality. We aimed to assess incidence, perioperative risk factors, treatment modalities and outcomes.
MATERIAL AND METHODS
A university medical center audit comprised 4883 consecutive patients (median age 69 [interquartile range IQR 60-76] years, 33% female, median logistic EuroScore 5 [IQR 3-11]) undergoing all types of cardiac surgery including surgery on the thoracic aorta; patients undergoing repair of congenital heart disease, implantation of assist devices or cardiac transplantation were excluded. Coronary artery disease was the leading indication for on-pump cardiac surgery (60%), patients undergoing cardiac surgery under urgency or emergency setting were included in analysis. We identified a total of 142 patients with gastrointestinal complications. To identify intra- and postoperative predictors for gastrointestinal complications, we applied a 1:1 propensity score matching procedure based on a logistic regression model.
RESULTS
Overall, 30-day mortality for the entire cohort was 5.4%; the incidence of gastrointestinal complications was 2.9% and median time to complication 8 days (IQR 4-12). Acute pancreatitis (n = 41), paralytic ileus (n = 14) and acute cholecystitis (n = 18) were the leading pathologies. Mesenteric ischemia and gastrointestinal bleeding accounted for 16 vs. 18 cases, respectively. While 72 patients (51%) could be managed conservatively, 27 patients required endoscopic/radiological (19%) or surgical intervention (43/142 patients, 30%); overall 30-day mortality was 12.1% (p<0.001). Propensity score matching identified prolonged skin-to-skin times (p = 0.026; Odds Ratio OR 1.003, 95% Confidence Interval CI 1.000-1.007) and extended on-pump periods (p = 0.010; OR 1.006, 95%CI 1.001-1.011) as significant perioperative risk factors.
COMMENT
Prolonged skin-to-skin times and extended on-pump periods are important perioperative risk factors regardless of preoperative risk factors.
Identifiants
pubmed: 31166962
doi: 10.1371/journal.pone.0217874
pii: PONE-D-19-03790
pmc: PMC6550404
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0217874Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Angiology. 2014 May;65(5):425-9
pubmed: 23574750
Am J Surg. 1985 May;149(5):648-50
pubmed: 3993848
J Cardiothorac Surg. 2013 Jun 18;8:156
pubmed: 23777600
Tex Heart Inst J. 2000;27(2):93-9
pubmed: 10928493
Cardiol Rev. 2007 Sep-Oct;15(5):231-41
pubmed: 17700382
Perfusion. 2006 Jul;21(4):215-23
pubmed: 16939115
N Engl J Med. 1991 Aug 8;325(6):382-7
pubmed: 1712076
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1268-1274
pubmed: 28800983
World J Surg. 2001 Sep;25(9):1140-4
pubmed: 11571949
Shock. 2017 Mar;47(3):296-302
pubmed: 28195969
Ann Thorac Surg. 1994 May;57(5):1193-9
pubmed: 8179384
Eur J Cardiothorac Surg. 1999 Jul;16(1):9-13
pubmed: 10456395
Ann Surg. 2007 Aug;246(2):323-9
pubmed: 17667513
Tex Heart Inst J. 2003;30(4):280-5
pubmed: 14677737
Yonsei Med J. 2013 Jan 1;54(1):154-9
pubmed: 23225812
Thorac Cardiovasc Surg. 1994 Jun;42(3):152-7
pubmed: 7940485
Ann Surg. 2005 Jun;241(6):895-901; discussion 901-4
pubmed: 15912039
Br J Surg. 1991 Mar;78(3):293-6
pubmed: 2021841
Can J Surg. 2003 Jun;46(3):176-82
pubmed: 12812238
J Card Surg. 2010 Mar;25(2):188-97
pubmed: 20149010
J Thorac Cardiovasc Surg. 1995 Sep;110(3):819-28
pubmed: 7564451
Dig Surg. 2018;35(2):171-176
pubmed: 28704814
ANZ J Surg. 2013 Sep;83(9):651-6
pubmed: 23530720