Thomas French, Dimitrios Damaskos, Darja Clinch, Charilaos-Panagiotis Koutsogiannidis
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引用次数: 0
Abstract
Aim: Gastrointestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of postoperative mortality. The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication.
Methods: This was a retrospective cohort study of 6769 consecutive patients undergoing cardiac surgeries (at least one of coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 1 January 2015 and 27 September 2023. Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a gastrointestinal GI complication.
Results: Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p < 0.001) and in-hospital mortality (6.8% vs 1.1%, p < 0.001) compared with those who did not. We identified previous percutaneous coronary intervention (PCI) (Odds ratio (OR) 2.27 [1.24-4.17], p = 0.007) and combined cardiac surgery (OR 1.67 [1.02-2.74], p = 0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (postoperative atrial fibrillation, postoperative vascular complication, use of pre-operative inotropes and increased age).
Conclusions: GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal are mesenteric ischemia, GI bleeding, and small bowel obstruction. Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease. Prompt emergency laparotomy is a potentially life-saving intervention in promptly diagnosed patients, but confers a high risk of intra-operative and thirty-day mortality.
目的：心脏手术后胃肠道（GI）并发症并不常见，但与术后死亡率高相关。本研究的目的是确定心脏手术后易发生胃肠道并发症的危险因素，并描述发生胃肠道并发症的患者的预后。方法：这是一项回顾性队列研究，在2015年1月1日至2023年9月27日期间，6769名连续接受心脏手术的患者（至少一次冠状动脉旁路移植术（CABG），主动脉瓣置换术，二尖瓣置换术或胸主动脉手术）在苏格兰的一个中心。比较了有和没有发生胃肠道并发症的患者的队列人口统计、术中细节和术后结果。结果：与未发生胃肠道并发症的患者相比，发生胃肠道并发症的患者30天死亡率（14.4% vs 2.4%, p < 0.001）和住院死亡率（6.8% vs 1.1%, p < 0.001）更高。我们确定既往经皮冠状动脉介入治疗（PCI）（优势比（OR） 2.27 [1.24-4.17], p = 0.007）和联合心脏手术（OR 1.67 [1.02-2.74], p = 0.043）是发生胃肠道并发症的两个危险因素，此外还有几个先前确定的危险因素（术后心房颤动、术后血管并发症、术前使用肌力药物和年龄增加）。结论：消化道并发症常发生在老年、合并症患者中，并伴有其他并发症。特别致命的是肠系膜缺血、胃肠道出血和小肠梗阻。在接受一次以上心脏手术的患者组或有冠状动脉疾病史的患者组应特别注意。对于及时诊断的患者，及时的紧急剖腹手术是一种潜在的挽救生命的干预措施，但术中死亡率和30天死亡率的风险很高。
期刊介绍：
Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.
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