Perioperative risk factors for serious gastrointestinal complications treated by laparotomy after cardiac surgery using cardiopulmonary bypass

Introduction

Gastrointestinal (GI) complications are rare but often fatal consequences of cardiac surgery, especially after cardiopulmonary bypass (CPB) operations. The therapy can be conservative or - in critical cases - surgical; however, an early and safe diagnosis may prevent the development of life-threatening GI complications. The aim of our study was to characterize the risk factors and perioperative predictors for GI complications treated by laparotomy after CPB operations.

Methods

In a retrospective analysis of 12 years of CPB operations, 13,553 consecutive patients were involved in the study. Laparotomy was performed after CPB in 277 (2.01%) cases, the mean follow-up time was 63.9 months.

Results

Logistic regression analysis of the preoperative data demonstrated RR = 1.585 (OR: 1.340 to 1.876, P < 0.001) for heart failure according to the NYHA classification. The postoperative data analysis showed an RR = 12.257 (OR: 9.604 to 15.643, P < 0.001) for the need of an IABP implantation and an RR = 13.455 (OR: 10.516 to 17.215, P < 0.001) of low output syndrome in the GI complications group. In contrast, GI disease in the patient history seemed not to be a significant risk factor. Preoperative renal failure had an RR = 2.181 (OR: 1.686 to 2.821, P < 0.001) until postoperative renal failure had an RR = 29.145 (OR: 21.322 to 39.839, P < 0.001).

Conclusions

A failing heart may play a significant role in critical GI complications after CPB, whereas history of GI disease does not seem to determine its incidence.