Mastoraki et al identified risk factors for biliary complications in patients who have just undergone cardiovascular surgery. Biliary complications are rare but can be life-threatening when they occur. A delay in diagnosis or surgery can be fatal.


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)


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