Inzidenz und Auswirkungen von Arrhythmien nach viszeralchirurgischen Eingriffen für Operationen am unteren Gastrointestinaltrakt

Incidence and impact of arrhythmias after visceral surgery for lower gastrointestinal tract

by Mara Sophie Hedicke
Doctoral thesis
Date of Examination:2024-08-27
Date of issue:2024-07-26
Advisor:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Miriam Puls
Persistent Address: http://dx.doi.org/10.53846/goediss-10638

 

 

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Abstract

English

The occurrence of arrhythmias in the postoperative course is not uncommon, but in visceral surgery, particularly in the lower gastrointestinal tract, it is not as frequently encountered or investigated as it is in cardiac and thoracic surgery, for example. The aim of this study was therefore to determine the incidence of postoperative arrhythmias after visceral surgery in the colorectal area and to identify their possible causes and effects. For this purpose, 1171 patients (559 female, 612 male) who underwent such surgery at the Department of General, Visceral and Paediatric Surgery at the University Medical Centre Göttingen between 2012 and 2018 were included in the study. The analysis of this data revealed an overall incidence of 4.7% of postoperative arrhythmias (PA), the majority of which (69%) could be diagnosed as tachycardic atrial fibrillation. Significantly higher incidences of PA were found for two types of surgery: Surgery for mesenteric ischaemia (26.92%) and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (16.67%). This is presumably due to increased stress caused by previous illnesses or intraoperative strain on the patients. Both multi-organ failure and advanced age of the patient increased the incidence of PA. The association with a longer length of stay and increased in-hospital mortality was also demonstrated in patients who developed PA. Looking at the immediate postoperative course, the median time of onset was determined to be 66.5 hours after surgery. As most patients had already left the intensive care unit with continuous monitoring at this time, it can only be surmised that the number of unreported cases may be significantly higher. In the follow-up of patients with PA after discharge from hospital, permanent arrhythmia or thromboembolic events were recorded. In just under a quarter of PA patients, the arrhythmias persisted over the long term. In summary, the incidence of postoperative arrhythmias after lower GI tract surgery does not appear to be particularly high in comparison but is associated with serious consequences. Further studies and investigations in this direction would be desirable in order to identify conceivable undetected PA and to investigate a more precise long-term course of disease in patients after discharge from hospital. In this way, high-risk groups for PA could possibly be identified and perioperative management adapted to prevent the occurrence of new PA and associated complications.
Keywords: atrial fibrillation; colorectal surgery; lower gastrointestinal tract surgery; postoperative arrhythmias; retrospective study; visceral surgery
 
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