Abstract
Introduction: Earlier studies have shown that re-operation for bleeding after cardiac surgery is associated with increased mortality and morbidity in both acute and elective patients. The aim of the study was to assess the effect of re-operation for bleeding on short- and long-term survival and the causes of re-operation on an exclusively elective population. Methods: This was a single-center, retrospective study conducted at the Department of Cardiothoracic Surgery at Copenhagen University Hospital. Rigshospitalet, Denmark. We included all elective patients undergoing first-time coronary bypass, valve surgery or combinations hereof between January 1998 and February 2014. Data was obtained from the electronic patient records on demographics, cardiological risk profile, blood transfusion and surgical record. Results: A total of 11813 patients were included in the analysis of whom 626 (5.3%) patients underwent re-operation for bleeding. Patients were divided into two groups; non re-operated (NRO) and re-operated(RO). Baseline characteristics were comparable. Median survival was lover in the RO group (142 vs 160months (P = 0.001)). Morbidity and 30 day mortality was significantly higher in the RO group. Cox-regression analysis showed a significantly increased age-adjusted risk of death in the RO group (HR 1.21(1.07-1.37). P = 0.003). In 85% of the patients the site of bleeding was found during the re-operation. Conclusion: We found both short and long-term survival to be lower in the RO group. A surgical cause for re-operation was found in the majority of cases. The study shows the importance of meticulous hemostasis during cardiac surgery.
Highlights
Earlier studies have shown that re-operation for bleeding after cardiac surgery is associated with increased mortality and morbidity in both acute and elective patients
Early postoperative bleeding is a serious complication after cardiac surgery, as it can lead to haemodynamic instability, cardiac tamponade, blood transfusions and a need for re-sternotomy and a worse outcome for the patient
Materials and methods Design This was a single-center retrospective study conducted at the Department of Cardiothoracic Surgery at Rigshospitalet, Copenhagen, Denmark
Summary
Earlier studies have shown that re-operation for bleeding after cardiac surgery is associated with increased mortality and morbidity in both acute and elective patients. The aim of the study was to assess the effect of re-operation for bleeding on short- and long-term survival and the causes of re-operation on an exclusively elective population. The reoperation in it self has been shown to increase mortality more than fourfold.[1] A further detrimental effect of transfusions of red blood cells (RBCs) has in retrospective studies been associated with an up to four times increase in mortality, both on short- and long-term follow-up,[2,3] though this detrimental effect has been elusive in prospective randomized trials. We hypothesized that re-operation for bleeding increased short- and long-term mortality
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