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Early Reexploration for Bleeding Is Associated With Improved Outcome in Cardiac Surgery. Ann Thorac Surg 2023 Jan;115(1):232-239

Date

08/12/2022

Pubmed ID

35952856

DOI

10.1016/j.athoracsur.2022.07.037

Scopus ID

2-s2.0-85136724747 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Reexploration after cardiac surgery, most frequently for bleeding, is a quality metric used to assess surgical performance. This may cause surgeons to delay return to the operating room in favor of attempting nonoperative management. This study investigated the impact of the timing of reexploration on morbidity and mortality.

METHODS: This study was a single-institution retrospective review of all adult cardiac surgery patients from July 2010 to June 2020. Time to reexploration was assessed, and outcomes were compared across increasing time intervals. Reported bleeding sites were classified into 5 groups, and bleeding rate (chest tube output) was compared across bleeding sites. Univariable analysis was performed using the Fisher exact and Kruskal-Wallis tests. Multivariable logistic regression models were used for risk-adjusted analyses.

RESULTS: Of 10 070 eligible patients, 251 (2.5%) required reexploration for postoperative bleeding. The most common site of bleeding was "any suture line" (n = 70; 28%). Interestingly, in 30% of cases (n = 75) "no active bleeding" site was reported. The highest rate of bleeding (mL/h) was observed in the "any mediastinal structure" group (median, 450; interquartile range [IQR], 185, 8878), and the lowest rate was noted in the "no active bleeding" group (median, 151.2; IQR, 102, 270). Both morbidity rates (0-4 hours, 12.3% vs 25-48 hours, 37.5%; P = .001) and mortality rates (0-4 hours, 3.1% vs 25-48 hours, 43.8%; P = .001) escalated significantly with increasing time to reexploration.

CONCLUSIONS: Delayed reexploration for bleeding after cardiac surgery is associated with increased risk for morbidity and mortality. Early surgical intervention, particularly within 4 hours, may improve outcomes. Implications from using reoperation as a performance metric may lead to unnecessary delay and patient harm.

Author List

Shou BL, Aravind P, Ong CS, Alejo D, Canner JK, Etchill EW, DiNatale J, Prokupets R, Esfandiary T, Lawton JS, Schena S

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Cardiac Surgical Procedures
Humans
Logistic Models
Morbidity
Postoperative Hemorrhage
Reoperation
Retrospective Studies
Risk Assessment