Intestinal ischemia after cardiac surgery: analysis of a large registry
Open accessAbstract
Background: Intestinal ischemia after cardiac surgery is a rare but severe complication with a high mortality. Early surgery can be lifesaving. The aim was to analyze the incidence, outcome, and risk factors for these patients. Methods: A prospectively collected database with patients who underwent 18,879 cardiac surgical procedures between 1996 and 2011 was investigated. All patients with registered gastrointestinal complications were retrospectively reviewed. Univariate and multivariate analyses were performed to compare patients with and without intestinal ischemia. Results: Seventeen patients suffered from intestinal ischemia (0.09%), 10 of whom (59%) died. By investigating preoperative parameters independent risk factors were steroids, peripheral vascular disease, cardiogenic shock, and New York Heart Association class 4. When including pre-, per-, and postoperative parameters, only postoperative ones were significant, including elevated creatinine (> 200 μmol/L), prolonged ventilator time, need for intra-aortic balloon pump, and cerebrovascular insult (CVI). The gastrointestinal complications score (GICS) showed a ROC area of 0.87. This was superior compared with EuroSCORE (0.74), to predict intestinal ischemia. Conclusions: Intestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients.
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Serum creatinine with a cut-off of 200 micromol/L had sensitivity 58% and specificity 97% in a single study.
“Serum creatinine with a cut-off of 200 micromol/L (58 and 97%) [90].”
From Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis (2023) · cites this paper as [90]
The Methods define postoperative renal failure as serum creatinine above 200 μmol/L, and Results Table 5 identifies that threshold as a risk factor for intestinal ischemia after cardiac surgery. The paper reports an odds ratio, not the claimed 58% sensitivity and 97% specificity; searches for those performance figures found no supporting passage. (LLM, conf=0.84)
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References 30 · Cited by 60
- Authors
- Nilsson, J., Hansson, E., & Andersson, B.
- Affiliations
- Lund University (SE)
- Corresponding author
- Andersson, Bodil
- Venue
- Journal of Cardiothoracic Surgery
- Published
- 2013-06-18
- Volume
- 8
- Issue
- 1
- Pages
- 156-156
- ISSN
- 1749-8090 (ISSN-L)
- PMC
- PMC3688391
- OpenAlex
- W2171174302
- Cited by
- 60
- References
- 30
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 8 · 2023: 5 · 2022: 9 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 3 · 2014: 5 · 2013: 1
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Cardiothoracic Surgery (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion, other-oa)
- Funders
- Hjärt-Lungfonden
- Svenska Läkaresällskapet
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- intestinal ischemia, postoperative complications, cardiac surgery, gastrointestinal complications, risk factors, mortality, corticosteroids, peripheral vascular disease, cardiogenic shock, intra-aortic balloon pump, prolonged mechanical ventilation, EuroSCORE
- MeSH terms
- Aged, Female, Cardiac Surgical Procedures, Humans, Intestines, Ischemia, Male, Middle Aged, Postoperative Complications, Registries, Retrospective Studies, Risk Factors, ROC Curve, Sweden, Incidence, Logistic Models, Statistics, Nonparametric
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