Key result
Gastrointestinal complications after cardiac surgery are linked to ~288% higher in-hospital mortality.
Why the study?
Gastrointestinal complications occur in approximately 1 of 20 patients undergoing cardiac surgery and carry adverse consequences, but contemporary analyses are lacking.
Are gastrointestinal complications following elective cardiac surgery associated with increased mortality and healthcare utilization?
Cohort (n=650,667)
Yes
Are gastrointestinal complications following elective cardiac surgery associated with increased mortality and healthcare utilization?
Effect estimate: adjusted OR 3.88 (95% CI 3.56-4.23)
Gastrointestinal complications after elective cardiac surgery occur in 4.2% of patients and are strongly associated with increased in-hospital mortality, longer length of stay, and higher costs, though care at high-volume centers mitigates this risk.
May warrant enhanced monitoring after cardiac surgery; leaves open whether mitigation strategies improve survival.
BACKGROUND: Gastrointestinal complications occur in ∼1 of 20 patients undergoing cardiac surgery and are associated with adverse consequences, although contemporary analyses are lacking. METHODS: All elective adult (≥18) hospitalizations entailing coronary artery bypass grafting, valve procedures, or a combination thereof were identified in the 2016-2021 Nationwide Readmission Database. Institutions were stratified by annual hospital cardiac surgery volume, with the highest quartile defined as high-volume hospitals. Outcomes included in-hospital mortality, perioperative complications, failure to rescue, length of stay, and inpatient costs. Multivariable regression models were used to evaluate the association of gastrointestinal complications with outcomes of interest. RESULTS: Of an estimated 650,667 patients, 27,023 (4.2%) developed gastrointestinal complications. The incidence of gastrointestinal complications increased from 3.5% to 4.6% (nptrend < .001), whereas failure to rescue declined from 17.6% to 14.8% over the study period (nptrend < .001). Compared with others, patients with gastrointestinal complications were older (69 vs 67 years, P < .001) and less commonly female (25.4 vs 29.3%, P < .001). Furthermore, those with gastrointestinal complications had increased odds of in-hospital mortality (adjusted odds ratio 3.88, 95% confidence interval 3.56-4.23), 90-day length of stay (β +2.14, 95% confidence interval 0.54-3.75), and 90-day inpatient costs (β +$8,400, 95% confidence interval 7800-8,900). Care at high-volume hospitals was associated with reduced odds of gastrointestinal complications (adjusted odds ratio 0.91, 95% confidence interval 0.86-0.97) and failure to rescue (adjusted odds ratio 0.93, 95% confidence interval 0.89-0.98). CONCLUSION: Gastrointestinal complications following cardiac surgery is independently associated with inferior outcomes, and a volume-outcome relationship was identified. Continued research efforts are warranted to understand mechanisms and risks to prevent and manage gastrointestinal complications.
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Gao et al. (2025) conducted a cohort in Cardiac surgery (n=650,667). Gastrointestinal complications vs. No gastrointestinal complications was evaluated on In-hospital mortality (adjusted OR 3.88, 95% CI 3.56-4.23). Gastrointestinal complications following cardiac surgery were associated with significantly increased odds of in-hospital mortality (adjusted OR 3.88; 95% CI 3.56-4.23).
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