GASTROINTESTINAL COMPLICATIONS AFTER AORTIC-SURGERY

Background and Purpose: A major gastrointestinal complication (GIC) af ter aortic surgery may be disastrous, but these complications have rec eived scant attention. This study was performed to determine the risk factors, associated events, and outcomes for patients with GIG. Method s: We performed a secondary analysis of a prospective study that exami ned 120 consecutive patients who underwent transperitoneal aortic reva scularization for aneurysmal or occlusive disease. Results: The follow ing 29 GICs developed in 25 patients (21%) within 30 days of aortic su rgery: paralytic ileus that required replacement of nasogastric tubes (n = 12), upper gastrointestinal bleeding (n = 5), Clostridium diffici le enterocolitis (n = 5), acute cholecystitis (n = 2), mechanical obst ruction (n = 2), ascites (n = 2), and colon ischemia (n = 1). Seven pa tients required operations for GICs after aortic revascularization. A comparison of patients with and without GICs showed no differences in the prevalence of risk factors, presence of mesenteric artery stenoses , coexisting medical illnesses, antecedent gastrointestinal history, o perative indication, preoperative fluid administration, or duration of operation. However, patients with GICs had more intraoperative compli cations (P = .004), greater intraoperative blood loss (P = .02), and m ore fluids during the postoperative period (P = .008). The mean durati on of mechanical ventilation was 71 +/-: 23 hours for patients with GI Cs versus 7 +/- 2 hours for patients without GICs (P = .006). A higher prevalence of pulmonary (P = .004) and renal (P = .001) complications was seen in the patients with GICs. The mean stay in the intensive ca re unit was 16 +/- 2 days for patients with GICs as compared with 5 +/ - 0.4 days for patients without GICs (P < .001). four deaths occurred, all caused by multisystem organ failure: 3 patients had GICs, and 1 d id not have a GIC (P = .007). Conclusions: These results show that GIC s are prevalent in transperitoneal aortic surgery and are associated w ith severe morbidity rates, increased hospital costs because of prolon ged stay, and increased mortality rates. Some GICs appear to be associ ated with intraoperative events that lead to visceral hypoperfusion, a nd others can be attributed to mechanical causes. However, none of the variables examined in this study were predictive of GICs. In all, GIC s should be considered serious adverse sequela after aortic revascular ization. Because no risk factors for GICs have been identified, these complications currently cannot be prevented.