Gastrointestinal complications in cardiac surgery patients are linked to high mortality and multiorgan failure.

IntroductionGastrointestinal (GI) complications after cardiac surgery, although uncommon (0.4–3%), are associated with high mortality rates (13–63%). This study aimed to describes outcomes of GI complications and propose a risk score predicting their occurrence.MethodsWe conducted a retrospective case–control study including 8,544 patients undergoing cardiac surgery between 2005 and 2019. GI complications—defined as bleeding, ischemia/perforation, obstruction, or pancreatitis—were used to select cases for 1:2 propensity score matching with controls. Multivariable logistic regression was performed to determine independent predictors of a composite endpoint (postoperative pulmonary, renal, and cardiac complications). A GI complication risk score was then developed.ResultsAfter matching, 162 patients were analyzed (54 GI group, 108 controls). Smokers and patients with significant coronary artery disease were more frequent in the GI group (p = 0.0049 and p = 0.0013). GI complications included ischemia (50.6%), hemorrhage (31.5%), pancreatitis (3.7%), and obstruction (14.8%), with 24.1% occurring as part of multiorgan failure. Overall mortality in the GI group was 38.8% compared with 0.9% in controls (p 2, and preoperative acute myocardial ischemia. The risk score, incorporating smoking, age, chronic kidney disease, and mitral valve replacement, showed good discrimination (area under the curve 0.735, 95% CI 0.653–0.816) and calibration (Hosmer–Lemeshow p = 0.934).ConclusionsMortality remains high among patients who develop GI complications after cardiac surgery, regardless of treatment modality. This risk score represents a potentially valuable tool for identifying patients at increased risk and underscores the importance of close monitoring and timely intervention in this population.