Predictors of general surgical complications after heart transplantation

BACKGROUND: Several studies have reported the incidence, morbidity, and mor tality of general surgical conditions (GSCs) in orthotopic heart transplant (OHT) patients. The following is the largest reported series of such patie nts and the first study with sufficient patient numbers to formally evaluat e peritransplant variables as risk factors for GSC development. STUDY DESIGN: A GSC was defined as a condition for which a general surgeon had been consulted or as a general surgical condition recognized at the tim e of autopsy. The records of 453 consecutive patients who underwent OHT bet ween 1981 and 1999 were reviewed to identify patients who developed a GSC. Kaplan-Meier actuarial analysis on this cohort, and univariate and multivar iate logistic regression models applied to a subpopulation of 324 consecuti ve OHT patients between 1987 and 1997 were used to determine factors associ ated with and predictive of GSC after OHT. RESULTS: Of 453 OHT patients, 371 (81.9%) were men, and the average age was 44.5 +/- 15 (standard deviation) years. Median followup was 2,086 days (ra nge 1 to 6,642 days). Ninety-three patients (20.5%) developed 111 GSCs. Of these, 78 were men, and the average age was 49.9 +/- 10.2 years. There were 83 general surgical interventions, Actuarial analysts revealed that age gr eater than 50 years, pretransplant, diagnosis of ischemic (PTDxI) versus no nischemic heart disease, and previous general surgical history were factors associated (p < 0.05) with a higher GSC incidence. Gender, more urgent tra nsplant priority status, cardiopulmonary bypass rime, total graft ischemic rime, and intensive care unit length of stay were not associated with GSC. Factors associated with GSC on univariate analysis, with odds ratios (ORs) and 95% confidence intervals (CIs) included: age analyzed as a continuous v ariable (OR 1.04 per year; CI 1.01, 1.06 per year; p = 0.0021), PTDxI (OR 2 .40; CI 1.39, 4.15; p = 0.0016), and pretransplant general surgical history (OR 3.35; CI 1.65, 6.82; p = 0.0008), Multivariate analysis revealed that only pretransplant general surgical history (OR 3.27; CI 1.58, 6.76; p = 0. 0004) and PTDsI (OR 2.37; CI 1.35, 4.16; p = 0.0023) were associated with s ubsequent development of GSC. CONCLUSIONS: A pretransplant diagnosis of ischemic heart disease and previo us history of a general surgical procedure are two independent risk factors that predispose OHT patients to development of GSC. Because GSC may arise insidiously in immunosuppressed patients, identification of OHT patients at higher risk for GSC will permit timely intervention decisions, decreasing morbidity and mortality in this challenging group of patients. (J Am Coll S urg 2001;193: 52-59. (C) 2001 by the American College of Surgeons).