Types of biliary complications encountered:
(1) gangrene with perforation
(2) acute acalculous cholecystitis
(3) distension of common bile duct
(4) cholelithiasis
(5) empyema
Manifestations are often subtle:
(1) distended abdomen
(2) elevated white blood cell count
(3) elevated C reactive protein
(4) elevated serum lactate
(5) elevation in transaminases
(6) unexplained sepsis
Risk factors (affected vs controls):
(1) advanced age (66 vs 63.5 years; use >= 65 years of age)
(2) male gender
(3) combined cardiac surgical procedures (CABG and aortic valve replacement, etc.)
(4) preoperative left ventricular ejection fraction < 45% (low cardiac output)
(5) prolonged time on bypass (170 minutes vs 107 minutes; use >= 120 minutes)
(6) prolonged aortic cross-clamp time (129 vs 68 minutes; use >= 80 minutes)
(7) prolonged mechanical ventilation after surgery (> 48 hours)
(8) use of intra-aortic balloon pump (IABP)
(9) multiple blood transfusions (use >= 3)
(10) presence of the systemic inflammatory response syndrome (SIRS, see Chapter 30)
(11) visceral hypoperfusion and ischemia
(12) administration of inotropes to maintain blood pressure (infers hypotension)
