Reoperation for bleeding in an elective cardiac surgical population - Does it affect survival?

Abstract

Introduction: Earlier studies have shown that re-operation for bleeding after cardiac surgery is associated with increased mortality and morbidity in both acute and elective patients. The aim of the study was to assess the effect of re-operation for bleeding on short- and long-term survival and the causes of re-operation on an exclusively elective population. Methods: This was a single-center, retrospective study conducted at the Department of Cardiothoracic Surgery at Copenhagen University Hospital. Rigshospitalet, Denmark. We included all elective patients undergoing first-time coronary bypass, valve surgery or combinations hereof between January 1998 and February 2014. Data was obtained from the electronic patient records on demographics, cardiological risk profile, blood transfusion and surgical record. Results: A total of 11813 patients were included in the analysis of whom 626 (5.3%) patients underwent re-operation for bleeding. Patients were divided into two groups; non re-operated (NRO) and re-operated(RO). Baseline characteristics were comparable. Median survival was lover in the RO group (142 vs 160months (P = 0.001)). Morbidity and 30 day mortality was significantly higher in the RO group. Cox-regression analysis showed a significantly increased age-adjusted risk of death in the RO group (HR 1.21(1.07-1.37). P = 0.003). In 85% of the patients the site of bleeding was found during the re-operation. Conclusion: We found both short and long-term survival to be lower in the RO group. A surgical cause for re-operation was found in the majority of cases. The study shows the importance of meticulous hemostasis during cardiac surgery.

Early chest re-exploration after adult cardiac surgery

“…5 The commonly used criteria for diagnosing excessive bleeding post cardiac surgery are the Kirklin and Barratt-Boyes criteria which include one or more the following findings: (1) drainage of more than 500ml blood during the first hour after cardiac surgery, more than 400 ml during each of the first two hours, more than 300 ml during each of the first three hours, more than one litre in total during the first four hours, and more than 1200ml in total during the first five postoperative hours; (2) excessive bleeding that restarts (indicating a possible surgical cause); and/or (3) sudden massive bleeding. 6,7 Other causes of early re-sternotomy after cardiac surgery are haemodynamic instability which may be due to accumulation of blood in the mediastinum causing cardiac tamponade, coronary graft occlusion or right ventricular dysfunction. The haemodynamic instability can be manifested as low cardiac output, low blood pressure or dysrhythmias.…”