Risk factors for gastrointestinal complications in patients undergoing coronary artery bypass graft surgery.

摘要

OBJECTIVE: To determine the risk factors for the development of gastrointestinal complications (GICs) after coronary artery bypass graft (CABG) surgery. DESIGN: A single-center, retrospective study. SETTING: A tertiary care hospital. PARTICIPANTS: Six thousand seven hundred ninety-four patients undergoing isolated CABG surgery between 2002 and 2006. INTERVENTIONS: Clinical characteristics of the patients with GICs and control group patients were analyzed by stepwise logistic regression analysis. The control group consisted of a total of 95 patients randomly selected among the ones who had no gastrointestinal finding or symptoms (cohort: control, 1:5 ratio). MEASUREMENTS AND MAIN RESULTS: Nineteen patients (0.3%) developed major surgical GICs after CABG surgery. Overall, the 30-day mortality was 42.1% among patients with GICs and 2.6% without GICs. Multivariate analysis identified 4 independent predictors for GICs: age greater than 70 years (p = 0.001; odds ratio [OR] = 5.6; 95% confidence interval [CI], 2.1-25.9), reoperation for bleeding (p = 0.005; OR = 7.7; 95% CI, 2.8-56.2), a prolonged cardiopulmonary bypass time (p = 0.007; OR = 3.7; 95% CI, 1.3-15.6), and an increased postoperative creatinine level (p = 0.036; OR = 2.3; 95% CI, 1.1-13.4). CONCLUSION: A delayed diagnosis of complications is an important problem in the management of major surgical GICs. The present results suggest that surgeons and intensivists must be alert to patients older than 70 years, a cardiopulmonary bypass time longer than 60 minutes, reoperation for bleeding after CABG surgery, and postoperative creatinine level higher than 1.7 mg/dL.