Abstract
Surgical re-explorations represent 3–5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR). Single center retrospective review of patients who underwent mediastinal re-exploration in the ICU or in the OR after cardiac surgery. Mediastinal re-explorations were also classified as: “planned” and “unplanned”. Primary outcome was 30-day mortality, secondary outcomes include deep sternal wound infection (DSWI), sepsis, ICU and hospital length of stay, prolonged intubation (>72 h), tracheostomy, pneumonia, acute kidney injury requiring dialysis and stroke. Between 2010 and 2019, 195 of 7263 patients (2.7%) underwent mediastinal re-exploration after cardiac surgery. More patients in the ICU group experienced two or more re-explorations (30.3% vs. 2.3%, p < 0.001), a higher incidence of postoperative pneumonia (22% vs. 7%, p = 0.004), prolonged intubation (46.8% vs. 19.8%, p < 0.001) and longer hospital stay (30.3 ± 34.2 vs. 20.8 ± 18.3 days, p = 0.014). There were no differences in mortality between ICU and OR (16.5% vs. 13.9%, p = 0.24) nor in sepsis (14.7% vs. 7%, p = 0.91) and DSWI rates (1.8% vs. 1.2%, p = 0.14). Re-explorations in the ICU were not associated with increased mortality, sepsis and mediastinitis rate.
Highlights
Mediastinal re-explorations in the immediate postoperative period account for 3–5%of all cardiac surgical procedures [1,2,3,4]
When we focus on the subgroup of re-explorations in the intensive care unit (ICU), the main finding is that unplanned procedures had lower mortality rates than planned re-explorations, which points to an acute and effective resolution of emergent life-threatening conditions when surgery is performed without delay
Reinterventions performed in the ICU were not associated with increased
Summary
Mediastinal re-explorations in the immediate postoperative period account for 3–5%of all cardiac surgical procedures [1,2,3,4]. Mediastinal re-explorations in the immediate postoperative period account for 3–5%. The most frequent emergent causes are excessive postoperative bleeding, cardiac arrest, arrhythmias and cardiac tamponade. Some patients cannot undergo sternal closure at the end of the index procedure because of hemodynamic instability, myocardial edema or persistent bleeding, despite accurate hemostasis and correction of any coagulation derangement. In such a case, the mediastinum is packed with sponges and the sternum is left open to be closed after the underlying condition has been solved. There is limited literature on the safety of re-explorations carried out in the intensive care unit (ICU). Concerns regarding mortality and major morbidity still remain [5,6,7,8]
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