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. 2019 Jun 5;14(6):e0217874.
doi: 10.1371/journal.pone.0217874. eCollection 2019.

Gastrointestinal complications following on-pump cardiac surgery-A propensity matched analysis

Katharina Marsoner  1 , Andreas Voetsch  2   3 , Christoph Lierzer  1 , Gottfried H Sodeck  4 , Sonja Fruhwald  5 , Otto Dapunt  2 , Hans Joerg Mischinger  1 , Peter Kornprat  1
Affiliations

Gastrointestinal complications following on-pump cardiac surgery-A propensity matched analysis

Katharina Marsoner et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
CABG Coronary artery bypass grafting.
Fig 2
Fig 2. Treatment and outcome details of all patients with gastrointestinal complications.
S surgical intervention, I interventional treatment, M medical treatment, CT computed tomography, GIC gastrointestinal complication, SMA superior mesenteric artery, GI gastrointestinal.
See this image and copyright information in PMC

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