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An Analysis of 1477 Cardiac Surgery Patients

Richard A. Perugini, MD; Richard K. Orr, MD, MPH; Deborah Porter, MD, MEd; Elisabeth M. Dumas, RN; Baltej S. Maini, MD

Arch Surg. 1997;132(4):352-357.

Abstract
Objective
To determine preoperative and perioperative risk factors for gastrointestinal (GI) complications following cardiac surgery.

Design
A database including records of patients who underwent cardiac surgery was reviewed, with univariate analysis of several variables thought to be relevant to GI complications. Using a risk-adjusted model, preoperative stratification was used to fit a logistic regression model including operative features.

Setting and Patients
All patients undergoing cardiac surgery from January 1, 1991, to December 31, 1994, at a university-affiliated teaching hospital.

Main Outcome Measures
Incidence of GI complications, postoperative mortality, length of hospital stay, and relative risk of GI complications based on multivariate analyses.

Results
Gastrointestinal complications occurred in 2.1% of patients and had an associated mortality of 19.4%; this was higher than the mortality in patients without GI complications (4.1%; P<.001). Length of hospital stay was significantly longer in patients with GI complications (43 vs 13.4 days; P<.001). In patients who underwent coronary artery bypass grafting only, cardiopulmonary bypass time was significantly longer in patients with GI complications (166 vs 138 minutes; P=.004). In patients who underwent valve replacement, bypass time was not associated with GI complications. Use of a left internal mammary artery graft was associated with a lower incidence of GI complications.

Conclusions
Patients who have GI complications after cardiac surgery have a higher mortality and a longer hospital stay. The use of a left internal mammary artery seems to have a protective effect against GI complications. Based on these observations, patients may be stratified into low-, medium-, and high-risk groups.

Arch Surg. 1997;132:352-357

Author Affiliations
From the Department of Surgery, Fallon Healthcare System (Drs Orr and Maini and Ms Dumas), and the Departments of Surgery (Drs Perugini, Orr, and Maini) and Anesthesiology (Dr Porter), University of Massachusetts Medical School, Worcester.

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