Long-term prognosis and a prediction model for acute bowel ischaemia following cardiac surgery
| Autor: | Mahmoud Loubani, Michael E. Cowen, Ajith Vijayan, Alexander R.J. Cale, Yama Haqzad, Sendhil Balasubramanian, Priyadharshanan Ariyaratnam |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors medicine.medical_treatment Population Risk Factors Internal medicine Laparotomy medicine Humans Hospital Mortality cardiovascular diseases Cardiac Surgical Procedures education Survival rate Aged Retrospective Studies education.field_of_study business.industry Mortality rate Perioperative Prognosis medicine.disease United Kingdom Surgery Cardiac surgery Survival Rate Mesenteric ischemia Mesenteric Ischemia Acute Disease Cardiology Female Cardiology and Cardiovascular Medicine business Complication Follow-Up Studies |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. 21:336-341 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1093/icvts/ivv148 |
| Popis: | OBJECTIVES: Bowel ischaemia following cardiac surgery is associated with a high postoperative mortality. No scoring system exists as yet to predict this complication following surgery. In addition, the long-term survival is not known. We sought to evaluate in-hospital outcomes and long-term outcomes in bowel ischaemia following cardiac surgery. We also sought to devise a simple risk prediction model for this catastrophic entity. METHODS: This was a retrospective study of data entered prospectively into our cardiac surgical database between July 1999 and May 2014. We compared the short- and long-term outcomes of patients who developed bowel ischaemia following cardiac surgery with those who did not develop bowel ischaemia using propensity-matched analysis. We developed a prediction model for bowel ischaemia from logistic regression. RESULTS: In total, 13 853 patients underwent cardiac surgery. Of these, 85 had confirmed bowel ischaemia following surgery. The inhospital mortality rate for those with bowel ischaemia was 60%, while in those without bowel ischaemia, the mortality rate was 3% (P< 0.0001). In those bowel ischaemia patients who had a laparotomy for corrective surgery, the in-hospital mortality was significantly less compared with those who did not have a laparotomy (39.2 vs 91.2%, P< 0.0001). The long-term survival for bowel ischaemia at 2, 6 and 10 years was 35% (±5), 31% (±5) and 26% (+/6), respectively. Multivariable analysis revealed that advanced age at surgery, peripheral vascular disease, intra-aortic balloon pump usage, NYHA IV and postoperative atrial fibrillation were the significant (P< 0.005) determinants of developing postoperative bowel ischaemia. We developed a model to predict bowel ischaemia and validated it within our population (c-index = 0.781). CONCLUSIONS: We have shown that whilst bowel ischaemia carries a higher short-term mortality, the long-term mortality is not significantly greater for those few who survive to discharge. We have developed a simple prediction model to identify those at high risk of developing bowel ischaemia following cardiac surgery in order to optimize perioperative strategies in future. |
| Databáze: | OpenAIRE |
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