The Effect of Postoperative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Surgery

José L. Díaz-Gómez, Benjamin Nutter, Meng Xu, Daniel I. Sessler, Colleen Koch, Joseph Sabik, C. Allen Bashour

Research output: Contribution to journalArticle

Abstract

Background: Gastrointestinal (GI) complications after coronary artery bypass graft surgery (CABG) are uncommon but associated with a disproportionate share of mortality. We thus identified variables associated with GI complications and analyzed their effect on postoperative mortality in patients undergoing isolated CABG. Methods: Information from patients who underwent isolated CABG at our institution during a 12-year period was obtained from the Anesthesiology Institute patient registry. Patients who experienced one or more postoperative GI complication(s) during their initial intensive care unit stay were identified. Multivariable logistic regression with backward variable selection was used to determine variables associated with GI complications and to evaluate their effect on mortality. Results: Among 16,043 patients who underwent isolated CABG, 213 (1.43%) had one or more GI complication(s). The main patient variables associated with postoperative GI complications included preoperative (odds ratio, 2.43; 95% confidence interval [CI], 1.39 to 4.23; p <0.001) and intraoperative (odds ratio, 5.07; 95% CI, 3.08 to 8.35; p <0.001) intraaortic balloon pump insertion, patient age (odds ratio, 1.65; 95% CI, 1.41 to 1.94; p <0.001), intraoperative fresh-frozen plasma transfusion (odds ratio, 3.38; 95% CI, 2.12 to 5.41; p <0.001), and cardiogenic shock (odds ratio, 3.04; 95% CI, 1.12 to 8.24). No difference was detected in complication rates between off-pump and on-pump CABG procedures (1.50% versus 1.30%, respectively; p = 0.63). Postoperative GI complication(s) after CABG was associated with a 12.98 times increase in mortality (p <0.001). Conclusions: This single-center cohort study indicates that GI complications after isolated CABG remain rare with an incidence 1.43%. However, GI complications portend a significant mortality. The implications of intraoperative administration of fresh-frozen plasma and insertion of an intraaortic balloon pump deserve further investigation as they are associated with GI complications.

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalAnnals of Thoracic Surgery
Volume90
Issue number1
DOIs
StatePublished - Jul 2010
Externally publishedYes

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Coronary Artery Bypass
Transplants
Odds Ratio
Confidence Intervals
Mortality
Anesthesiology
Cardiogenic Shock
Intensive Care Units
Registries
Cohort Studies
Logistic Models
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The Effect of Postoperative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Surgery. / Díaz-Gómez, José L.; Nutter, Benjamin; Xu, Meng; Sessler, Daniel I.; Koch, Colleen; Sabik, Joseph; Bashour, C. Allen.

In: Annals of Thoracic Surgery, Vol. 90, No. 1, 07.2010, p. 109-115.

Research output: Contribution to journalArticle

Díaz-Gómez, José L. ; Nutter, Benjamin ; Xu, Meng ; Sessler, Daniel I. ; Koch, Colleen ; Sabik, Joseph ; Bashour, C. Allen. / The Effect of Postoperative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Surgery. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 1. pp. 109-115.
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abstract = "Background: Gastrointestinal (GI) complications after coronary artery bypass graft surgery (CABG) are uncommon but associated with a disproportionate share of mortality. We thus identified variables associated with GI complications and analyzed their effect on postoperative mortality in patients undergoing isolated CABG. Methods: Information from patients who underwent isolated CABG at our institution during a 12-year period was obtained from the Anesthesiology Institute patient registry. Patients who experienced one or more postoperative GI complication(s) during their initial intensive care unit stay were identified. Multivariable logistic regression with backward variable selection was used to determine variables associated with GI complications and to evaluate their effect on mortality. Results: Among 16,043 patients who underwent isolated CABG, 213 (1.43{\%}) had one or more GI complication(s). The main patient variables associated with postoperative GI complications included preoperative (odds ratio, 2.43; 95{\%} confidence interval [CI], 1.39 to 4.23; p <0.001) and intraoperative (odds ratio, 5.07; 95{\%} CI, 3.08 to 8.35; p <0.001) intraaortic balloon pump insertion, patient age (odds ratio, 1.65; 95{\%} CI, 1.41 to 1.94; p <0.001), intraoperative fresh-frozen plasma transfusion (odds ratio, 3.38; 95{\%} CI, 2.12 to 5.41; p <0.001), and cardiogenic shock (odds ratio, 3.04; 95{\%} CI, 1.12 to 8.24). No difference was detected in complication rates between off-pump and on-pump CABG procedures (1.50{\%} versus 1.30{\%}, respectively; p = 0.63). Postoperative GI complication(s) after CABG was associated with a 12.98 times increase in mortality (p <0.001). Conclusions: This single-center cohort study indicates that GI complications after isolated CABG remain rare with an incidence 1.43{\%}. However, GI complications portend a significant mortality. The implications of intraoperative administration of fresh-frozen plasma and insertion of an intraaortic balloon pump deserve further investigation as they are associated with GI complications.",
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AU - Díaz-Gómez, José L.

AU - Nutter, Benjamin

AU - Xu, Meng

AU - Sessler, Daniel I.

AU - Koch, Colleen

AU - Sabik, Joseph

AU - Bashour, C. Allen

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N2 - Background: Gastrointestinal (GI) complications after coronary artery bypass graft surgery (CABG) are uncommon but associated with a disproportionate share of mortality. We thus identified variables associated with GI complications and analyzed their effect on postoperative mortality in patients undergoing isolated CABG. Methods: Information from patients who underwent isolated CABG at our institution during a 12-year period was obtained from the Anesthesiology Institute patient registry. Patients who experienced one or more postoperative GI complication(s) during their initial intensive care unit stay were identified. Multivariable logistic regression with backward variable selection was used to determine variables associated with GI complications and to evaluate their effect on mortality. Results: Among 16,043 patients who underwent isolated CABG, 213 (1.43%) had one or more GI complication(s). The main patient variables associated with postoperative GI complications included preoperative (odds ratio, 2.43; 95% confidence interval [CI], 1.39 to 4.23; p <0.001) and intraoperative (odds ratio, 5.07; 95% CI, 3.08 to 8.35; p <0.001) intraaortic balloon pump insertion, patient age (odds ratio, 1.65; 95% CI, 1.41 to 1.94; p <0.001), intraoperative fresh-frozen plasma transfusion (odds ratio, 3.38; 95% CI, 2.12 to 5.41; p <0.001), and cardiogenic shock (odds ratio, 3.04; 95% CI, 1.12 to 8.24). No difference was detected in complication rates between off-pump and on-pump CABG procedures (1.50% versus 1.30%, respectively; p = 0.63). Postoperative GI complication(s) after CABG was associated with a 12.98 times increase in mortality (p <0.001). Conclusions: This single-center cohort study indicates that GI complications after isolated CABG remain rare with an incidence 1.43%. However, GI complications portend a significant mortality. The implications of intraoperative administration of fresh-frozen plasma and insertion of an intraaortic balloon pump deserve further investigation as they are associated with GI complications.

AB - Background: Gastrointestinal (GI) complications after coronary artery bypass graft surgery (CABG) are uncommon but associated with a disproportionate share of mortality. We thus identified variables associated with GI complications and analyzed their effect on postoperative mortality in patients undergoing isolated CABG. Methods: Information from patients who underwent isolated CABG at our institution during a 12-year period was obtained from the Anesthesiology Institute patient registry. Patients who experienced one or more postoperative GI complication(s) during their initial intensive care unit stay were identified. Multivariable logistic regression with backward variable selection was used to determine variables associated with GI complications and to evaluate their effect on mortality. Results: Among 16,043 patients who underwent isolated CABG, 213 (1.43%) had one or more GI complication(s). The main patient variables associated with postoperative GI complications included preoperative (odds ratio, 2.43; 95% confidence interval [CI], 1.39 to 4.23; p <0.001) and intraoperative (odds ratio, 5.07; 95% CI, 3.08 to 8.35; p <0.001) intraaortic balloon pump insertion, patient age (odds ratio, 1.65; 95% CI, 1.41 to 1.94; p <0.001), intraoperative fresh-frozen plasma transfusion (odds ratio, 3.38; 95% CI, 2.12 to 5.41; p <0.001), and cardiogenic shock (odds ratio, 3.04; 95% CI, 1.12 to 8.24). No difference was detected in complication rates between off-pump and on-pump CABG procedures (1.50% versus 1.30%, respectively; p = 0.63). Postoperative GI complication(s) after CABG was associated with a 12.98 times increase in mortality (p <0.001). Conclusions: This single-center cohort study indicates that GI complications after isolated CABG remain rare with an incidence 1.43%. However, GI complications portend a significant mortality. The implications of intraoperative administration of fresh-frozen plasma and insertion of an intraaortic balloon pump deserve further investigation as they are associated with GI complications.

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