Long-term Outcome of Reexploration for Bleeding After Coronary Artery Bypass Grafting

Abstract

Objectives This study aims to determine the influence of re-exploration for bleeding and blood product requirement after CABG on long-term mortality. Design Retrospective cohort study Setting Single centre Participants All patients who underwent CABG between January 1998 and December 2019 were included. Interventions The parameters were analyzed to assess the association between re-exploration for bleeding and long-term mortality. Measurements and main results The primary endpoint was all-cause mortality up to end of follow-up (1st. June 2021). The secondary endpoints were 30-day mortality, duration of admission, blood product transfusion, postoperative use of IABP, deep sternal wound infection, myocardial infarction and neurological complications. Cox proportional hazards model was used to assess the association between both re-exploration and blood product use and all-cause mortality. Median follow-up was 9.7 years (IQR 5.1 – 14.6]. In total, 576 out of 21,346 (2.7%) patients were re-explored for bleeding. Thirty-day mortality was 6.2% vs 1.6% for the re-explored vs not re-explored patients. Re-exploration for bleeding was not significantly correlated with long-term mortality (HR 1.029; P =.068). On the other hand, blood product transfusion (HR=1.135; P <.001), and in particular pRBC transfusion (HR=1.139; P <.001) were significantly associated with higher long-term mortality. After multivariate cox regression using ≥5 pRBC transfused as a cut-off point, re-exploration for bleeding was not significantly associated with long-term mortality (HR 0.982; P =.813). Receiving ≥5 pRBC was significantly associated with higher long-term mortality (HR 1.249; P <.001). Conclusion Re-exploration for bleeding is significantly associated with higher 30-day mortality but not with long-term mortality. Poorer long-term mortality was attributed to patient characteristics and higher use of postoperative blood products.