Incidence of gastrointestinal complications in cardiopulmonary bypass patients

Gastrointestinal complications after cardiac surgery are associated with a high mortality rate. Because of the absence of early specific clinical sign s, diagnosis is often delayed. The present study seeks to determine predict ive risk factors for subsequent gastrointestinal complications after cardio surgical procedures. Within a I-year period, a total of 1116 patients who h ad undergone open heart surgery with cardiopulmonary bypass were prospectiv ely studied for gastrointestinal complications. To determine predictive fac tors, all case histories of the patients were analyzed. Of the 1116 patient s, 23 (2.1%) had gastrointestinal complications during the postoperative pe riod, 10 of whom had to undergo subsequent abdominal surgery. Of these 23 p atients, 20 died. Early gastrointestinal complications, which occurred most ly on postoperative days 6 or 7, consisted of bowel ischemia or hepatic fai lure. Late complications were gastrointestinal bleeding, pseudomembranous c olitis, cholecystitis, and septic rupture of a spleen. The relative risk fo r abdominal complications after cardiopulmonary bypass was highly increased in association with (1) a cardiac index less than 2.0 l/min(-1)/(m(2))(-1) , (2) postoperative onset of atrial fibrillation, (3) emergency surgery, (4 ) need for vasopressors, (5) need for intraaortic balloon counterpulsation, and (6) need for early redo thoracotomy due to surgical complications. All patients with necrotic bowel disease had elevated serum lactate levels. Fu rthermore, cardiopulmonary bypass and aortic clamping times were significan tly prolonged in patients who developed gastrointestinal complications. A n umber of predictive factors contribute to the development of gastrointestin al complications after cardiopulmonary bypass surgery. Knowledge of these f actors may lead to earlier identification of patients at increased risk and may allow more efficient and earlier interventions to reduce mortality.