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

Abstract

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.

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

“…In 2021, Elassal et al performed a retrospective analysis of adult patients who underwent cardiac re-exploration in a trial to control postoperative bleeding. They reported 565 adult patients underwent re-exploration for postoperative unstopped bleeding between February 2006 and May 2019 [Elassal 2021].…”

Coronary Artery Bypass Grafting among Patients Undergoing Cardiac Surgery in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

“…Re-exploration leads to significant blood transfusion, adverse effects on cardiorespiratory functions, increased period of mechanical ventilation support, prolonged intensive care unit stay, hospital stay, and increase mortality. 18 …”

The Role of Absorbable Gelatin Sponge (Gel Foam) in Control of Sternal Bleeding during Cardiac Surgery

“…Acute respiratory distress syndrome (ARDS), atrial arrhythmias, renal failure, sepsis, and stroke, as well as lengthy mechanical ventilation inotropic support, were morbidities linked to re-exploration as an independent risk factor (17) . Re-exploration cases in the Elassal study had a greater rate of deep sternal wound infections DSWI, extended durations of MV, ICU reside, and stay in hospital, and more blood and blood products requirements (19) . Potential worse consequences were linked to re-exploration and transfusion needs independently.…”

“…The rate of reoperation was 2.4%, and the deaths for re-explored cases was 9.1% compared to 2% for those non-reexplored. Also, Elassal et al (19) stated that re-explored class had elevated deaths frequency than non-reexplored cases (15.4% versus 2.53%).…”