The Impact of Re-Opening Post Cardiac Surgery on Short and Long- Term Outcomes: 11 Years Follow Up

Abstract

Objective: Re opening immediately post major cardiac surgery is a problematic complication. Studies suggest bleeding and/or tamponade post cardiac surgery significantly affects in hospital mortality and length of stay. The primary objective of this study was to compare the short- and long-term outcomes of patients who were reopened with those who were not reopened (Control) following cardiac surgery using propensity matched analysis. Methods: In total, 7960 patients underwent cardiac surgery. 539 (6.8%) were reopened immediately post cardiac surgery for either bleeding or tamponade. Patients were propensity score matched (525 reopened versus 525 control) by age, gender, operative priority, preoperative arrhythmia, Ejection Fraction, Euroscores, logistic Euroscores, type of cardiac operation, Body Mass Index, bypass time and cross clamp times. Data were collected prospectively and follow up obtained to date on all patients. Statistical analysis was performed using IBM SPSS version 22. Results: The overall rate of re exploration was 6.8%. After propensity score matching the baseline demographics, pre-operative and intra operative variables were comparable between the two groups. Therefore, patients with similar risk profiles were compared between RE and Control group. Significantly higher rate of post-operative arrhythmias, myocardial infarctions, renal complications, wound infections, cerebrovascular accidentsm, ulatnisdystem failure were observed in the RE group compared to Control group (p>0.001). RE group on average had longer ICU stay and total hospital stay (p>0.001). RE group had significantly higher 30-day mortality 23.4% (vs. 6.3% p<0.001) and long term mortality 37% (vs. 22.9% log rank <0.001) compared to Control group. However, patients who were discharged alive had a comparable long-term survival 82.4% vs. 84.9% between the RE and Control group (log rank <0.396). Significant predictors of reopening post cardiac operation were; poor left ventricular function, pre-operative Intra-Aortic Balloon Pump (IABP), and post-operative arrhythmias (p<0.001). However, reopening in itself was a significant predictor of in hospital mortality (p<0.001). Conclusion: Reopening for bleeding and/or Tamponade saves lives. However, in this propensity matched study we have shown that reopening is also associated with a significantly higher rate of post-operative complications; hospital stay, short- and long-term mortality compared to similar risk profile patients who were not reopened. Re opening post cardiac operation is an independent predictor of in hospital mortality. Meticulous haemostasis is required to reduce risk of bleeding/tamponade and prevent re opening post cardiac surgery.