Mj. Ott et al., POSTOPERATIVE ABDOMINAL COMPLICATIONS IN CARDIOPULMONARY BYPASS PATIENTS - A CASE-CONTROLLED STUDY, The Annals of thoracic surgery, 59(5), 1995, pp. 1210-1213
Intraabdominal complications (IAC) after cardiopulmonary bypass often
are difficult to diagnose and are associated with high mortality (13%
to 67%). From 1984 to 1991 we retrospectively analyzed 53 patients und
ergoing cardiopulmonary bypass for coronary artery bypass grafting, va
lve reconstruction, or arch reconstruction who experienced 55 episodes
of IAC and compared them with matched control patients (matched for o
peration, age, and sex). The overall incidence of IAC was 0.65%. Univa
riate analysis identified the following preoperative variables as sign
ificantly (p < 0.05) increasing the risk of IAC: history of congestive
heart failure, chronic renal failure, and more than three medical pro
blems. A history of congestive heart failure was the most powerful pre
dictor by multivariate analysis (p = 0.045). Early post-cardiopulmonar
y bypass complications were increased significantly in IAC patients. T
hese included acute renal failure (p < 0.0001), cerebrovascular accide
nts (p < 0.03), and lower extremity ischemia (p < 0.05). Twenty-eight
of 38 laparotomies performed were diagnostic. However, analysis of 58
combined clinical, radiologic, and laboratory tests failed to identify
which predicted the diagnostic utility of a laparotomy. Fifteen of th
e 53 IAC patients (28%) survived: 8 patients had had a therapeutic lap
arotomy, 1 patient underwent a nondiagnostic laparotomy, and 6 patient
s were managed nonoperatively. Multivariate analysis identified ventil
ator dependence (p = 0.004) and acute renal failure with creatinine le
vel greater than 1.9 mg/dL (p = 0.011) as the most powerful predictors
of mortality regardless of intervention. These data suggest a profile
of cardiac surgical patients at risk for IAC as well as those patient
s who are most likely to benefit from timely intervention.