(135) Evaluation of Routine Post-Cardiac Surgery Bowel Care at a Major Surgical Center

Introduction: Gastrointestinal (GI) complications after cardiac surgery carry risk for significant morbidity and mortality. The average incidence of GI complications is 1.2%, with an average mortality of 32%. Post-operative ileus (POI), a potential GI complication post-cardiac surgery, can lead to prolonged hospital stay, increased cost of care, and patient discomfort. There are no consensus guidelines defining an optimal bowel regimen to prevent GI complications.

Methods: This is a retrospective, observational cohort study. All adult (18 years or older) patients who received the routine post-cardiac surgery admission order set from July 2022 to July 2023 at Cleveland Clinic were included. Patients with missing data, who expired in the first 48 hours of intensive care unit (ICU) admission, who did not receive at least one dose of the standard regimen within 48 hours, who had pre-operative ileostomy, colostomy, or fecal management systems, or who tested positive for Clostridiodes difficile within 10 days before surgery were excluded. The standard bowel regimen was senna-docusate 8.6-50 milligrams twice daily and bisacodyl 10 milligrams suppository once daily as needed. The primary outcome was the incidence of post-operative constipation (no bowel movement within 72 hours of ICU admission). Secondary outcomes include the time to the first bowel movement, incidence of POI, as defined by Society of Thoracic Surgeons National Database, and number of adjustments made to the bowel regimen before the first bowel movement.

Results: Of the 3,531 patients screened, 3,457 were included. Common cardiac surgeries included valve repair or replacement and coronary artery bypass grafting. The incidence of post-operative constipation was 66.1% (n=2,284) with a median time to first bowel movement of 86.6 hours. POI occurred in 3% of patients. On average, 3.31 bowel regimen adjustments were made before the first bowel movement with the most common intervention being the addition of polyethylene glycol daily (82.8%).

Conclusions: There was a high incidence of constipation but a low incidence of POI. Multiple adjustments were required before the first bowel movement. A higher intensity bowel regimen is needed to prevent post-operative constipation after cardiac surgery.