Effect of Defecation Delay in Patients After Tricuspid Valve Replacement: A Retrospective Study
DOI:
https://doi.org/10.1532/hsf.5281Keywords:
Tricuspid regurgitation (TR), Tricuspid valve replacement (TVR), defecation delay, ICU, retrospective studyAbstract
Background: Defecation delay is a common symptom in patients after tricuspid valve replacement (TVR). Previous studies have demonstrated that defecation delay was associated with worse clinical outcomes of critically ill patients. Our study aimed to investigate the incidence and risk factors of defecation delay in patients after TVR and its adverse clinical outcomes.
Methods: A retrospective study was conducted in 206 patients undergoing TVR under cardiopulmonary bypass from May 2005 to July 2021. According to the first postoperative defecation time after surgery, patients were divided into the delayed group (>3 days) and control group (≤3 days). Baseline characteristics and preoperative, intraoperative, and postoperative data were collected to investigate the clinical outcomes of defecation delay.
Results: Among the 206 patients, 51.9% (107/206) cases were classified into the defecation delay group. Univariate analysis showed that age (P = 0.043), preoperative platelets (PLT) (P < 0.001), cardiopulmonary bypass (CPB) time (P = 0.013), minimum rectal temperature (P = 0.042), and the use of prokinetic drugs (P = 0.015) were significantly different in the two groups. In addition, the perioperative adverse events in the defecation delay group were significantly higher than that of the control group. Logistic regression analysis indicated that the mortality of patients was associated with postoperative renal dysfunction (P = 0.047) and postoperative respiratory failure (P = 0.004) but was not associated with defecation delay (P > 0.05).
Conclusion: Patients with defecation delay after TVR were more likely to appear adverse events, however, defecation delay was not associated with mortality after TVR.
References
Adike A, DiBaise JK. 2018. Small Intestinal Bacterial Overgrowth: Nutritional Implications, Diagnosis, and Management. Gastroenterol Clin North Am. 47(1):193-208.
Al Ali A, Singh R, Filler G, et al. 2021. Abdominal compartment syndrome secondary to chronic constipation in MECP2 duplication syndrome. BMJ Case Rep. 14(6).
Antunes MJ, Rodríguez-Palomares J, Prendergast B, et al. 2017. Management of tricuspid valve regurgitation: Position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease. Eur J Cardiothorac Surg. 52(6):1022-1030.
Ballabeni V, Barocelli E, Bertoni S, et al. 2002. Alterations of intestinal motor responsiveness in a model of mild mesenteric ischemia/reperfusion in rats. Life Sci. 71(17):2025-35.
Barberio B, Judge C, Savarino EV, et al. 2021. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6(8):638-648.
Belsey J, Greenfield S, Candy D, et al. 2010. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. 31(9):938-49.
Boilesen SN, Dias FC, Tahan S, et al. 2021. Fluid intake and urinary osmolality in pediatric patients with functional constipation. Eur J Nutr. 60(8):4647-4655.
Bragg D, El-Sharkawy AM, Psaltis E, et al. 2015. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 34(3):367-76.
Braun JP, Schroeder T, Buehner S, et al. 2004. Splanchnic oxygen transport, hepatic function and gastrointestinal barrier after normothermic cardiopulmonary bypass. Acta Anaesthesiol Scand. 48(6):697-703.
Chor CYT, Mahmood S, Khan IH, et al. 2020. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann. 28(9):621-632.
Correction to: 2020 ACC/AHA Guideline on the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2021. 143(10):e784.
de Azevedo RP, Freitas FG, Ferreira EM, et al. 2015. Daily laxative therapy reduces organ dysfunction in mechanically ventilated patients: a phase II randomized controlled trial. Crit Care. 19(1):329.
Diebakate-Scordamaglia L, Voican CS, Perlemuter G. 2022. Iatrogenic constipation in gastrointestinal surgery. J Visc Surg. 159(1s):S51-s57.
Dreyfus J, Flagiello M, Bazire B, et al. 2020. Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. Eur Heart J. 41(45):4304-4317.
Gacouin A, Camus C, Gros A, et al. 2010. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med. 38(10):1933-8.
Hellstrom EA, Ziegler AL, Blikslager AT. 2021. Postoperative Ileus: Comparative Pathophysiology and Future Therapies. Front Vet Sci. 8:714800.
Ivanov A, Yossef J, Tailon J, et al. 2016. Do pulmonary function tests improve risk stratification before cardiothoracic surgery? J Thorac Cardiovasc Surg. 151(4):1183-9.e3.
Kawano S, Tsuji S. 2000. Role of mucosal blood flow: a conceptional review in gastric mucosal injury and protection. J Gastroenterol Hepatol. 15 Suppl:D1-6.
Kollef MH, Schachter DT. 1991. Acute pulmonary embolism triggered by the act of defecation. Chest. 99(2):373-6.
Kongkatong MM, Patel MM, Thom C, et al. 2022. Fatal Abdominal Compartment Syndrome Due to Constipation: A Case Report. Clin Pract Cases Emerg Med. 6(1):8-12.
Launey Y, Painvin B, Roquilly A, et al. 2021. Factors associated with time to defecate and outcomes in critically ill patients: a prospective, multicentre, observational study. Anaesthesia. 76(2):218-224.
Lewis K, Alqahtani Z, McIntyre L, et al. 2016. The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Crit Care. 20(1):259.
Li J, Yang T, Cen L, et al. 2021. Defecation delay in patients after lung tumor surgery: a prospective nested case-control study. Ann Transl Med. 9(12):980.
Mounsey A, Raleigh M, Wilson A. 2015. Management of Constipation in Older Adults. Am Fam Physician. 92(6):500-4.
Pahwa S, Saran N, Pochettino A, et al. 2021. Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation. Eur J Cardiothorac Surg. 59(3):577-585.
Peng R, Li H, Yang L, et al. 2021. The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis. PLoS One. 16(1):e0245317.
Polsinelli VB, Marteau L, Shah SJ. 2019. The role of splanchnic congestion and the intestinal microenvironment in the pathogenesis of advanced heart failure. Curr Opin Support Palliat Care. 13(1):24-30.
Puleo F, Arvanitakis M, Van Gossum A, et al. 2011. Gut failure in the ICU. Semin Respir Crit Care Med. 32(5):626-38.
Raja K, Kochhar R, Sethy PK, et al. 2004. An endoscopic study of upper-GI mucosal changes in patients with congestive heart failure. Gastrointest Endosc. 60(6):887-93.
Rasmussen LS, Pedersen PU. 2010. Constipation and defecation pattern the first 30 days after thoracic surgery. Scand J Caring Sci. 24(2):244-50.
Seilitz J, Edström M, Sköldberg M, et al. 2021. Early Onset of Postoperative Gastrointestinal Dysfunction Is Associated With Unfavorable Outcome in Cardiac Surgery: A Prospective Observational Study. J Intensive Care Med. 36(11):1264-1271.
Stewart D, Waxman K. 2007. Management of postoperative ileus. Am J Ther. 14(6):561-6.
Topilsky Y, Maltais S, Medina Inojosa J, et al. 2019. Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting. JACC Cardiovasc Imaging. 12(3):433-442.
Valentova M, von Haehling S, Bauditz J, et al. 2016. Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure. Eur Heart J. 37(21):1684-91.
Vargas-García EJ, Vargas-Salado E. 2013. Food intake, nutritional status and physical activity between elderly with and without chronic constipation. A comparative study. Cir Cir. 81(3):214-20.
Vather R, Trivedi S, Bissett I. 2013. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg. 17(5):962-72.
Venara A, Neunlist M, Slim K, et al. 2016. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 153(6):439-446.
Wang YB, Liu J, Yang ZX. 2011. Effects of intestinal mucosal blood flow and motility on intestinal mucosa. World J Gastroenterol. 17(5):657-61.
Włodarczyk J, Waśniewska A, Fichna J, et al. 2021. Current Overview on Clinical Management of Chronic Constipation. J Clin Med. 10(8).
Yoshida T, Uchino S, Sasabuchi Y. 2022. Epidemiology of constipation in critically ill patients and its impact on in-hospital mortality: a retrospective observational study. J Anesth. 36(3):349-358.
Zack CJ, Fender EA, Chandrashekar P, et al. 2017. National Trends and Outcomes in Isolated Tricuspid Valve Surgery. J Am Coll Cardiol. 70(24):2953-2960.
Zhu LM, Fang XC, Liu S, et al. 2012. Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China. Zhonghua Yi Xue Za Zhi. 92(32):2243-6.
Zoumprouli A, Chatzimichali A, Papadimitriou S, et al. 2017. Gastrointestinal motility following thoracic surgery: the effect of thoracic epidural analgesia. A randomised controlled trial. BMC Anesthesiol. 17(1):139.
