Reoperation for bleeding in cardiac surgery

Abstract

At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We performed a case-note review on propensity-matched patients to assess the outcome of reoperation for bleeding regarding morbidity and mortality. In total, 101 patients (7.0%) underwent surgical re-exploration due to excessive postoperative bleeding. Significant risk factors for reoperation for bleeding after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher mortality. Surviving reoperated patients significantly had a lower EuroSCORE and a shorter time on ECC compared with non-survivors. The average time to re-exploration was 155 min longer for non-survivors when compared with survivors.

Cardiac surgery Emergency reoperation after open heart surgery: ten years of experience

“…The prevalence of reoperation in our study group was 4.3% and was similar to that of previously reported articles [3,[8][9][10][11]. All patients were reoperated in the operating theater.…”

The Effects of Different BMI on Blood Loss and Transfusions in Chinese Patients Undergoing Coronary Artery Bypass Grafting

“…They recommended that surgeries be planned carefully in patients with a high EuroSCORE, low ejection fraction (EF), low BMI, DM, preoperative s-creatinine >134 µmol/l or for procedures other than CABG. 26) In our study, a few cases required reoperation (low and normal weight, 1.2%; overweight patients, 0.6%; none among obese) and no significant differences were found between groups. Other studies have investigated the effect of obesity on surgical outcomes.…”

“…18,24) Deciding when a patient requires transfusion varies significantly among intensivists, anesthetists, and cardiac surgeons. 18,25,26) The use of blood and other blood product transfusions in cardiac surgical patients remains very high. 29) This large-scale study after primary CABG was conducted among exclusively ethnic Chinese and found lower blood loss and transfusion with elevated BMI.…”

Can Topical Application of Tranexamic Acid Reduce Blood Loss in Thoracic Surgery? A Prospective Randomised Double Blind Investigation

“…Re-thoracotomy for post-operative haemorrhage is a well known complication in cardio-thoracic surgery [6,7]. In thoracic surgery the reported incidence of re-exploration for bleeding ranges from 1 to 3.7% and the need for blood transfusion ranges from 20 to 52% in haemorrhagic patients [13,14].…”

“…[2][3][4][5]. At the same time different studies have shown that re-exploration for bleeding has a negative impact on patient outcome, increasing the morbidity rate and in-hospital mortality [6,7]. The systemic infusion of antifibrinolytic agents has been used effectively to reduce post-operative blood loss and transfusion requirements in different kinds of surgical procedures bleeding diathesis (haemophilia, etc.…”