Postoperative arrhythmia after lower gastrointestinal surgery- the blind spot of postoperative care?

Abstract

Abstract Introduction: Postoperative arrhythmias (PAs) are common events and have been widely investigated in cardiothoracic surgery. Within visceral surgery, a recent study revealed a significant occurrence of PA in esophageal resections. In contrast, PA in lower gastrointestinal surgery is rarely investigated and has been rudimentary described in the medical literature. Methods: In total, 1171 patients (559 female, 612 male) without any history of prior arrhythmia who underwent lower GI surgery between 2012 and 2018 were included and retrospectively analyzed. All included patients were treated and monitored in the intensive care unit (ICU) or intermediate care unit (IMC) after surgery. Follow-up was obtained for the patients with PA investigating the possible persistence of PA and complications such as permanent arrhythmia or thromboembolic events after discharge. Results: Overall, PA occurred in n=56 (4.8%) patients after surgery of the lower GI. The highest incidence of PA was seen in patients undergoing bowel surgery after mesenteric ischaemia (26.92%), followed by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC; 16.67%). PA was significantly associated with higher age (p<0.001) and longer length of stay in the ICU (p<0.001). PA was independently associated with organ failure (p<0.001) and higher in-house mortality (p<0.001). In median, PA occurred 66.5 hours after surgery. In follow-up, 31% of the patients showed development of permanent arrhythmia. Discussion: The incidence of PA after lower GI surgery is comparatively low. Its occurrence, however, seems to have severe implications since it is significantly associated with higher rates of organ failure and in-house mortality. Also, compared to the general population, the development of permanent arrhythmia is significantly higher in patients who developed new-onset PA.