POSTOPERATIVE ABDOMINAL COMPLICATIONS IN CARDIOPULMONARY BYPASS PATIENTS - A CASE-CONTROLLED STUDY

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.