Long-term outcome of patients undergoing re-exploration for bleeding following cardiac surgery: a SWEDEHEART study

Abstract

OBJECTIVES Excessive bleeding leading to re-exploration is a severe complication of cardiac surgical procedures, associated with early postoperative morbidity and mortality. Less is known about the long-term outcome of these patients. We evaluated the impact of re-exploration after cardiac surgery on peri- and postoperative morbidity and mortality, as well long-term mortality, in a well-defined nationwide population. METHODS In this retrospective study, 48 060 consecutive patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery from 2006 to 2015 were analysed. Multivariable logistic regression was used to identify factors associated with re-exploration, morbidity and mortality. Cox regression analysis was implemented to explore the association between re-exploration and long-term mortality. The mean follow-up time was 4.6 years (range 0–10 years) with follow-up time set at 31 December 2015. RESULTS Overall, 2371 patients (4.9%) underwent re-exploration. Factors associated with re-exploration included advanced age, procedures other than isolated CABG and acute surgery. Re-explored patients had an increased risk of unadjusted mortality at 30, 90 and beyond 90 days (all P < 0.001). Significance was maintained after adjustment at 30 days [odds ratio: 3.94, 95% confidence interval (CI): 3.19–4.85, P < 0.001] and 90 days (odds ratio: 3.79, 95% CI: 3.14–4.55, P < 0.001), but not with long-term mortality (hazard ratio: 1.02, 95% CI: 0.91–1.15, P = 0.712). Furthermore, re-exploration was independently associated with other postoperative complications, e.g. prolonged hospital stay, stroke and renal injury. CONCLUSIONS Patients who are re-explored for bleeding within 24 h have almost four-fold higher odds of mortality within 3 months post-procedure. However, the increased risk of death following re-exploration is not maintained in the long term.

A Retrospective Multicenter Experience: Does Packing the Surgical Field Help to Stop Bleeding After Cardiac Surgery

“…In our study, the mean age of patients was 62.7±5.6 years. This matches what was reported by Heimisdottir et al, who retrospectively reviewed more than 48,000 patients undergoing cardiac surgeries, either CABG or valve replacement, in the period between 2006 and 2015 [Heimisdottir 2022].…”

“…They also performed a Cox regression analysis to identify the associated risk factors for chest re-exploration. They reported that only 4.9% of patients needed re-exploration among included patients and that advanced age was significantly associated with an increased exploration rate among patients [Heimisdottir 2022].…”

Conservative Fluid Resuscitation Protocol Does Not Reduce the Incidence of Reoperation for Bleeding during the First 48 Hours after Emergency CABG

“…Pre-and intraoperative patient characteristics have been repeatedly shown to be worse in patients at risk for postoperative ROB after cardiac surgery. [39] These patients are signi cantly older, have higher rates of heart and renal failure, have higher EuroSCORE II and preoperative aPTT values, and have lower hemoglobin levels than patients who did not undergo ROB. [21] In addition, emergency surgery and prolonged aortic cross-clamp time are independent risk factors for ROB.…”

“…[21] In addition, emergency surgery and prolonged aortic cross-clamp time are independent risk factors for ROB. [39] The kidney is the organ most affected in critically ill patients. Fluid overload as a consequence of perioperative liberal uid management may explain why the incidence of renal dysfunction was higher in patients undergoing ROB.…”