Planned Versus Unplanned Reexplorations for Bleeding: A Comparison of Morbidity and Mortality

Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Sciortino, Christopher M.; Mandal, Kaushik; Zehr, Kenton J.; Cameron, Duke E.; Whitman, Glenn J.R.; Conte, John V.

doi:10.1016/j.athoracsur.2016.06.096

Cited by 4 publications

(5 citation statements)

References 15 publications

(25 reference statements)

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“…In our study, we observed a marked increase in the incidence of postoperative bleeding complications compared with that noted in non-COVID-19 patients. In our Unit, during the same period, the rate of overall surgical reexplorations for bleeding in non-Covid patients undergone CPB was 4% (30 out of 750 patients) consistent with previously reported results, [12][13][14][15] which was markedly lower than the rate of surgical reexplorations in the studygroup .…”

Section: Discussionsupporting

confidence: 92%

“…1,5,[7][8][9] Among coronavirus disease patients, the most frequent complications included interstitial pneumonia with respiratory failure and acute respiratory distress syndrome (ARDS), acute renal failure and thromboembolic events. 1,[6][7][8][9][10][11][12][13][14][15] However, during surgery in COVID-19 patients, perioperative bleeding was less observed, and has not been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

“…The mortality rate, the incidence of severe thrombocytopenia, need for blood components transfusions and procoagulant drugs, length of surgical hemostasis time (SHT), blood loss from drains, and length of hospitalization were also analyzed. [12][13][14][15] The aim of this study was to evaluate whether possible inflammatory reactions associated with perioperative COVID-19 infection could contribute to coagulation derangements of CPB and consequently, significantly increase the risk for hemorrhagic complications.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

Chiariello

Bruno

Pavone

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

Chiariello

Bruno

Pavone

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…Full equipment of OR including heart lung machine and IAB facilitate the job. Crash on site re-exploration was done in only three cases of [25]. Effective collaboration (multi-disciplinary teams) between cardiac surgeon, perfusionist, anesthetist, clinical pharmacist, and ICU physician is required to prevent and manage postoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate

Elassal

Al‐Ebrahim

Debis

et al. 2021

J Cardiothorac Surg

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Background Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. Objective To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. Methods Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. Results Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality. Conclusion Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.

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“…When these complications are difficult to correct through conservative treatment, in order to avoid further deterioration of the disease, patients often need to undergo secondary thoracotomy exploration. The reexploration will bring the patient a large amount of foreign blood products, the risk of mediastinal and deep soft tissue infections, and it is a prognostic factor for severe postoperative complications [8][9][10]. The surgical trauma of the second thoracotomy exploration and the perioperative volume control of the patient make the body prone to heart and kidney dysfunction, respiratory insufficiency, and even multiple organ dysfunction syndrome, which seriously affects the patient's prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of hospital mortality for unplanned re-exploration after cardiovascular surgery

Deng¹,

Zhong²

2021

Preprint

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Objective To explore the prognostic factors of hospital mortality for unplanned re-exploration after cardiovascular surgery. Methods We retrospectively analyzed the data of 100 patients who underwent unplanned re-exploration after cardiovascular surgery in our hospital between May 2010 and May 2020. There were 77 males and 23 females, aged (55.1±15.2) years. Demographic characteristics, operation information, perioperative complications were collected to set up a database. The patients were divided into survival group and non-survival group according to hospital mortality. Logistic regression was used for multivariable analysis to explore the prognostic factors of hospital mortality. These statistically significant indicators were selected for drawing the receiver operating characteristic curve of the evaluation model, calculating the area under the curve(AUC) and evaluating the effectiveness of the new model with Hosmer-Lemeshow C-statistic. Results Hospital mortality was 26.0% (26/100). Multivariate logistics regression revealed that the operation time of unplanned re-exploration, the worst blood creatinine within 48h before the re-exploration, the worst lactate within 24h after the re-exploration, cardiac insufficiency, respiratory insufficiency, and acute kidney injury were independent prognostic factors (p<0.05). The AUC of the new assessment model constituted by these prognostic factors was 0.910, and the Hosmer-Lemeshow C-statistic was 4.153 (P= 0.762). Conclusions The operation time of unplanned re-exploration, the worst blood creatinine value within 48h before the re-exploration, the worst lactate value within 24h after the re-exploration, cardiac insufficiency, respiratory insufficiency, and acute kidney injury were independent prognostic factors of hospital mortality for unplanned re-exploratio after cardiovascular surgery.

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Planned Versus Unplanned Reexplorations for Bleeding: A Comparison of Morbidity and Mortality

Abstract: Delayed sternal closure is a safe alternative to initial definitive chest closure when concern exists for postoperative bleeding.

Cited by 4 publications

References 15 publications

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate

Prognostic factors of hospital mortality for unplanned re-exploration after cardiovascular surgery

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