Intestinal ischaemia following cardiac surgery: a multivariate risk model

Eur J Cardiothorac Surg. 2006 Jun;29(6):971-7. doi: 10.1016/j.ejcts.2006.03.014. Epub 2006 May 3.

Abstract

Objective: Intestinal ischaemia following cardiac surgery is a serious complication, which carries a high mortality rate. Several studies have examined pre-operative and intra-operative risk factors. We aimed to develop a multivariate risk model to identify those patients at highest risk of intestinal ischaemia.

Methods: Data was prospectively collected for 10,976 consecutive cardiac surgery patients from our institution between April 1997 and March 2004. Fifty (0.5%) patients developed post-operative intestinal ischaemia. A forward stepwise multivariate logistic regression analysis was undertaken to identify predictors of developing intestinal ischaemia. Intra-operative and post-operative variables were censored at the time of onset of intestinal ischaemia.

Results: The predictors of post-operative intestinal ischaemia were: post-op inotrope and dialysis support (OR 6.7; p < 0.001), post-op ventilation >48 h (OR 5.1; p < 0.001), age at operation (OR 1.06 [for each additional year]; p < 0.001), post-op atrial fibrillation (OR 2.3; p = 0.014) and blood loss in intensive care unit (ICU) >700 ml (OR 2.0; p = 0.037). The predictive ability of this model was very good with an area under the receiver operating characteristic curve of 0.93. In-hospital mortality for the patients who developed intestinal ischaemia was 94% (47/50) compared to 3.6% (390/10,926) for the other patients (p < 0.001).

Conclusions: Although the incidence of intestinal ischaemia following cardiac surgery is low, the prognosis for these patients is very poor. We have identified several risk factors, and developed a multivariate prediction tool, which may be useful in identifying patients at high-risk of developing intestinal ischaemia.

MeSH terms

  • Acute Disease
  • Aged
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiopulmonary Bypass
  • England / epidemiology
  • Epidemiologic Methods
  • Female
  • Humans
  • Intestines / blood supply*
  • Ischemia / epidemiology
  • Ischemia / etiology*
  • Male
  • Middle Aged
  • Postoperative Care / methods
  • Prognosis