Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-25T08:34:42.234Z Has data issue: false hasContentIssue false
  • English
  • Français

Gastrointestinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

Nancy S. Ghanayem ,
Joseph A. Dearani ,
Karl F. Welke ,
Marie J. Béland ,
Irving Shen  and
Tjark Ebels
Nancy S. Ghanayem*
Affiliation:
Department of Pediatrics, Division of Critical Care, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
Joseph A. Dearani
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
Karl F. Welke
Affiliation:
Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon, United States of America
Marie J. Béland
Affiliation:
Division of Paediatric Cardiology, The Montreal Children’s Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
Irving Shen
Affiliation:
Inova Fairfax Hospital for Children, Falls Church, Virginia, United States of America
Tjark Ebels
Affiliation:
Groningen University Medical Centre, Groningen, The Netherlands
*
Correspondence to: Nancy Ghanayem MD, Division of Critical Care, Children’s Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, Wisconsin 53201, United States of America. Tel: (414) 266 3360; Fax: (414) 266 3563; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the gastrointestinal system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

Although serious gastrointestinal complications are relatively uncommon after congenital cardiac surgery, accurate estimates of the incidences of these complications are limited, in part due to lack of standardized reporting and the absence of universal nomenclature that defines organ-specific complications. The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has prepared and defined a list of gastrointestinal complications that may be temporally associated with congenital cardiac surgery. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Keywords

Congenital heart diseasequality improvementpatient safetyoutcomesregistryoperative morbiditypaediatricsurgerycongenital abnormalitiescardiac surgical proceduresheartgastrointestinal tract
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S2: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease , December 2008 , pp. 240 - 244
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.IIHessel, EA. Abdominal organ injury after cardiac surgery. Sem Cardiothorac Vasc Anesth 2004; 8: 243–263.CrossRefGoogle ScholarPubMed
2.D’Ancona, G, Baillot, R, Poirier, B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 2003; 30: 280–285.Google ScholarPubMed
3.Mavroudis, C, Jacobs, JP. Congenital Heart Surgery Nomenclature and Database Project: overview and minimum dataset. Ann Thorac Surg 2000; 69 (4 Suppl): S2–17.CrossRefGoogle ScholarPubMed
4.Franklin, RCG, Jacobs, JP, Tchervenkov, CI, et al. Report from the Executive of The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease: Bidirectional Crossmap of the Short Lists of the European Paediatric Cardiac Code and the International Congenital Heart Surgery Nomenclature and Database Project. Cardiol Young 2002; 12 (Suppl. II): 18–22.CrossRefGoogle Scholar
5.Ackland, G, Grocott, MPW, Mythen, MG. Understanding gastrointestinal perfusion in critical care; so near and yet so far. Crit Care Med 2000; 4: 269–281.Google ScholarPubMed
6.Takala, J. Determinants of splanchnic blood flow. Br J Anaesth 1996; 77: 50–58.CrossRefGoogle ScholarPubMed
7.Jakob, SM. Splanchnic bloodflow in low-flow states. Anaesth Analg 2003; 96: 1448–1457.Google Scholar
8.Izzo, JL, Taylor, AA. The sympathetic nervous system and baroreceptors in hypertension and hypotension. Curr Hypertens Rep 1999; 1: 254–263.CrossRefGoogle Scholar
9.Kimmerly, DS, Shoemaker, JK. Hypovolemia and neurovascular control during orthostatic stress. Am J Physiol Heart Circ Physiol 2002; 282: H645–655.CrossRefGoogle ScholarPubMed
10.Haljamae, H. Pathophysiology of shock. Acta Anesthesiol Scand 1993; 98: 3–6.CrossRefGoogle ScholarPubMed
11.Reilly, PM, Wilkins, KB, Fuh, KC, Haglund, U, Bulkley, GB. The mesenteric hemodynamic response to circulatory shock: an overview. Shock 2001; 15: 329–343.CrossRefGoogle ScholarPubMed
12.Bersten, AD, Hersch, M, Cheung, H, Rutledge, FS, Sibbald, WJ. The effect of various sympathomimetics on the regional circulations in hyperdynamic sepsis. Surgery 1992; 112: 549–561.Google ScholarPubMed
13.Meakins, JL, Marshall, JC. The gut as the motor of multiple system organ failure. In: Splanchnic Ischemia and Multiple Organ Failure. Marston, A, Buckley, GB, Fiddian-Green, R (eds). Edward Arnold, London, 1989, pp 339–348.Google Scholar
14.Aneman, A, Pettersson, A, Eisenhofer, G, et al. Sympathetic and renin-angiotensin activation during graded hypovolemia in pigs: impact on mesenteric perfusion and duodenal mucosal function. Shock 1997; 8: 378–384.CrossRefGoogle ScholarPubMed
15.Toung, T, Reilly, PM, Fuh, KC, Ferris, R, Bulkley, GB. Mesenteric vasoconstriction in response to hemorrhagic shock. Shock 2000; 13: 267–273.CrossRefGoogle ScholarPubMed
16.Deitch, EA, Morrison, J, Berg, R, Specian, RD. Effect of hemorrhagic shock on bacterial translocation, intestinal morphology, and intestinal permeability in conventional and antibiotic-decontamination rats. Crit Care Med 1990; 18: 529–536.CrossRefGoogle ScholarPubMed
17.Marshall, JC, Nathens, AB. The gut in critical illness: evidence from human studies. Shock 1996; 6: S10–S16.CrossRefGoogle ScholarPubMed