Assess the risk factors and outcomes for gastrointestinal (GI) complications in patients undergoing coronary artery bypass surgery (CABG).
We conducted a nested case-control study from a nine-year, hospitalization cohort (N=7345) in which data were collected prospectively. Cases were patients that developed GI complications (N=66) and controls were patients that did not develop GI complications (N=330). Cases were matched to controls 1:5 on type of surgery. There were 16 predictor and 14 outcome variables of interest.
Five significant predictor variables were discovered. Cases were more likely to be older than age seventy, with more left ventricular hypertrophy, more dialysis, greater urgency of the procedure, and more likely to be on anticoagulants. There were no significant differences between the cases and controls for the remaining 11 predictor variables of interest. Correlation coefficients were computed among the significant variables. Using regression analysis, patients undergoing CABG with age greater than 70 (RR 1.06, 95% CI 1.03–0.97), dialysis (RR1.87, 95% CI 1.98–1.22), and urgency of procedure (RR 1.91, 95% CI 1.07–3.4) had a three-fold increase in the risk of GI complication. There were 11 significant outcome variables. Patients with GI complications had more additional procedures, arrhythmia requiring treatment, mortality, neurological complications, pulmonary complications, renal complications, and sternal wound complications. Patients with GI complications also had greater length of hospitalization (LOH), intensive care unit LOH, post operative creatine phosphokinase levels, and ventilator time.
In patients undergoing CABG surgery, dialysis, age greater than 70, and increased urgency of the procedure all significantly increased the risk of a GI complication. Patients with GI complications also experienced more negative outcomes.
With this data, cardiac surgeons can accurately counsel patients on their individual risk of getting a gastrointestinal complication with undergoing CABG. This could lead to better informed decisions by both physicians and patients.
M.H. Recht, None.