Incidence, Indications, and Risk Factors of Reopening After Cardiac Surgery in Tertiary Cardiac Center, Sudan: Retrospective Observational Study

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Background: Chest re-opening after cardiac surgery is a surgical approach that is performed for diagnosis and management of some postoperative complications. The rate of reopening varies from 2% to 6% of patients undergoing cardiac surgery. The most frequent indication for reopening, followed by cardiac tamponade, cardiac arrest and redo surgery. Several risk factors have been associated with reopening such as, age, sex, BMI, NYHA class, diabetes mellitus, cardiopulmonary bypass and aortic cross clamp time. The aim of this study is to determine the incidence, indications, and risk factors of reopening after cardiac surgery. Methods: In this retrospective observational study, a total of consecutive 638 patients who underwent cardiac surgery in Ahmed Gasim cardiac center in 2017 were included. Results: The incidence of reopening was found to be 61 per 1000 in all age groups, 90 per 1000 in adults, and 34 per 1000 in paediatrics. Out of 39 reopening cases, Bleeding was found to be the most frequent indication of reopening. multivariate analysis by logistic regression revealed that, having NYHA class II odd ratio OR = 24.767 (95% confidence interval CI = 1.048 – 585.3), past cardiac surgery OR = 13.9(95% CI = 1.013 – 193.3), having diabetes mellitus OR = 4.885 (95% CI = 1.251 –19.056 ),longer cardiopulmonary bypass time OR = 1.012 (95% CI = 1.00 – 1.024), preoperative aspirin OR = 3.528 (95% CI = 1.062 – 11.720), and warfarin OR = 12.790 (95% CI = 1.594 – 102.3) all are associated with increased risk of reopening after cardiac surgery. Conclusion : Incidence of reopening in Sudan was relatively higher than the international records. Reopening was mostly performed for postoperative bleeding management. Cardiac failure assessed by NYHA classification, previous cardiac surgery, diabetes mellitus, anti thrombotic therapy and longer bypass time were associated with increased risk of reopening