Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy

Background: Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is asso ciated with high mortality. We investigated the incidence of hyperbilirubin aemia after two major types of thoracic surgery: open-heart surgery and oes ophagectomy. In order to identify the risk factors associated with hyperbil irubinaemia after major surgery, we compared the incidence after open-heart surgery with that after oesophagectomy. Results: Hyperbilirubinaemia was detected in 51% of the open-heart surgery patients (n=133) and in 64% in the oesophagectomy group (n=74). The inciden ce of hyperbilirubinaemia was significantly related to the duration of surg ery (P<0.05). In the open-heart surgery group, duration of surgery was 465 +/- 24 min for the patients without hyperbilirubinaemia and 571 +/- 26 min for the patients with hyperbilirubinaemia. In the oesophagectomy group, the procedure durations were 415 +/- 7 min and 493 +/- 20 min, respectively. T he overall mortality rate was 8% in the open-heart surgery group; the rate was 12% in those with hyperbilirubinaemia, but 5% in those without hyperbil irubinaemia. No members of the oesophagectomy group died, with or without h yperbilirubinaemia. Infection significantly affected both the occurrence of hyperbilirubinaemia and mortality in the open-heart surgery group. in the subgroups from the open-heart surgery group, 5% (three out of 65) of those without hyperbilirubinaemia (or evidence of infection) died; of the patient s with hyperbilirubinaemia, 3% (one out of 38) of those without infection d ied and 23% (seven out of 30) with detected infection died. Conclusion: After open-heart surgery and oesophagectomy, approximately half of the patients studied had higher levels of serum total bilirubin. Time s pent in surgery was significantly related to the occurrence of hyperbilirub inaemia. Infection significantly affected mortality and total bilirubin rev els after open-heart surgery. Control of infection plays a crucial role in the prevention of hyperbilirubinaemia and in reducing mortality.