Postoperative GI symptoms in cardiac surgery patients

Evaluation of taste sensitivity in patients undergoing coronary artery bypass graft surgery

Patients report changes in their perception of food tastes following cardiac surgery. This study was designed to explore changes in taste sensitivity following coronary artery bypass graft (CABG) surgery. Detection and recognition thresholds for sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) were determined using the multiple forced-choice ascending concentration series method at baseline (presurgical), discharge, 5 weeks, and 16 weeks post-CABG. Demographic and gastrointestinal data were also obtained. Mixed-model analyses for repeated measures were performed using the baseline scores as reference. Thirty-three patients (mean age=61.8+/-8 years), consented to participate in the study between January 2003 and January 2006, with 13 completing all visits. Detection and recognition thresholds for sweet were significantly lower at discharge compared with baseline (1.7+/-1.2 vs 2.43+/-1.4 and 5.1+/-1.8 vs 5.5+/-1.3, respectively; P<0.05). This difference remained significant 4 months after surgery. Detection and recognition thresholds for salt also declined with time, with significant differences at 4 months post-surgery (2.3+/-2.0 vs 1.8+/-1.5; P<0.001 and 5.3+/-1.3 vs 4.2+/-2.2; P<0.05, respectively). The same trends were noted for the detection of sour and the recognition of bitter. Patients undergoing CABG demonstrated stable or improved taste sensitivity during the recovery period. Further studies aimed at clarifying the relationships between the biological state, taste sensitivity, reported taste changes, and food intake will help to clarify the clinical impact of taste changes and subsequently to guide clinical nutrition care.

Examining Oral Intake Temperature in Cardiac Surgery Patients

The effect of restricting the temperature of cardiac surgery patients' oral intake to room temperature or warmer, over the first 3 postoperative days, on gastrointestinal (GI) symptoms was examined. In all, 57 patients were randomly assigned to receive the intervention or usual care. GI symptoms were measured daily over the first 5 postoperative days. Following hospital discharge, GI symptoms and return to function data were collected over 4 postoperative weeks. On Postoperative Day 1, 41% of patients reported having GI symptoms, and they were significantly associated with higher cross-clamp time. Symptoms dissipated over time. There were no differences between the study groups in GI symptoms or return to function. Nearly 70% of patients who withdrew from the study were randomized to the intervention group. Difficulty associated with adhering to the study protocol was their primary reason for withdrawing. Given these findings, a large-scale clinical trial may not be warranted.

The incidence of gastrointestinal symptoms in cardiac surgery patients through six weeks after discharge

OBJECTIVE

To determine the incidence and the effect of intraoperative and discharge variables on gastrointestinal (GI) symptoms after cardiac surgery during hospitalization and 2 and 6 weeks after discharge.

DESIGN

Prospective and descriptive.

SETTING

Two university-affiliated medical centers.

PATIENTS

One hundred twenty-two adult patients undergoing cardiac surgery.

OUTCOME MEASURES

Frequency of GI symptoms and level of distress caused by GI symptoms during hospitalization and 2 and 6 weeks after hospital discharge.

INSTRUMENTS

GI symptoms were measured by The Gastrointestinal Symptom Frequency and Symptom Distress Scale. Depression was measured by The Center for Epidemiologic Studies Depression Scale.

INTERVENTION

Demographic and physiologic variables were collected by chart review. Patients completed the Gastrointestinal Symptom Frequency and Symptom Distress Scale and The Center for Epidemiologic Studies Depression Scale in the hospital. Telephone interviews were used to collect 2- and 6-week data.

RESULTS

Fifty-seven percent of patients after surgery reported poor appetite, 37% lack of taste, and 34% nausea during hospitalization. The frequency of all GI symptoms decreased with time; 19% of subjects reported poor appetite, 19% lack of taste, and 10% nausea at 6 weeks after discharge. Although poor appetite occurred with the greatest frequency, patients reported the greatest distress with lack of taste. When analyzed with a logistic regression model, use of antihypertensive agents was associated with lack of taste; use of diuretic and antiarrhythmic agents was associated with nausea; and level of depression was associated with all three GI symptoms. Length of cardiopulmonary bypass time mean arterial blood pressure during surgery, mixed venous oxygen saturation during surgery, and subject age did not significantly affect the frequency of GI symptoms at any data collection point.

CONCLUSIONS

The incidence of GI symptoms after cardiac surgery is significant, but their etiology has yet to be determined.