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DOI: 10.1055/s-0032-1332338
Impact of re-exploration for bleeding or tamponade on outcome after cardiac surgery
Objectives: Bleeding necessitating re-exploration after cardiac surgery remains a frequent complication with adverse outcomes. The aim of this study was to evaluate the impact of re-exploration for bleeding or tamponade on outcome.
Methods: A retrospective, observational study on an age-, gender- and operation-matched cohort of 418 patients, who underwent re-exploration after cardiac surgery between 01/2005 and 12/2011, was performed.
Results: The intraoperative and postoperative transfusion requirements were higher in the re-exploration group (p < 0.01). Patients in the re-exploration group had significantly higher incidences of postoperative acute renal injury (AKI), respiratory failure and sternal wound infections, longer mechanical ventilation time and intensive care unit (ICU) stay, and higher mortality rate (9.6 vs. 3.3%; p < 0.05). However, in the multivariate logistic regression analysis re-exploration was not an independent risk factor for 30-day mortality. Transfusion and postoperative AKI were independent risk factors for 30-day mortality. The patients who were re-explored within 12h after surgery (73%) had shorter mechanical ventilation time and ICU stay and a lower mortality compared to the of patients who were re-explored 12h or later (27%) (p < 0.05). Also, patients who were re-explored for bleeding (82%) had better outcome compared to the of patients who were re-explored for tamponade (18%) (p < 0.05).
Conclusions: This study suggests that re-exploration after cardiac surgery is associated with increased mortality and morbidity. This risk is increased in patients with tamponade and if time to re-exploration is prolonged for 12h or longer.