Trends and Outcomes of Surgical Reexploration After Cardiac Operations in the United States

Abstract

BackgroundSurgical reexploration after cardiac surgery has been associated with increased in-hospital complications and mortality in limited series. The present study examined trends in reoperation and the impact of reoperation on clinical outcomes and resource use in a nationally representative cohort. The study sought to determine patient and hospital factors associated with reexploration and reoperative mortality, defined as failure to rescue surgical (FTR-S). MethodsAdult hospitalizations entailing cardiac operations (coronary artery bypass or valve) were identified using the 2005 to 2018 National Inpatient Sample. Procedures were tabulated using International Classification of Diseases codes. Hospitals were ranked into tertiles according to risk-adjusted mortality, with the lowest stratified as high performing. Multivariable regression models examined factors associated with reexploration, as well as clinical outcomes, including FTR-S and resource use. ResultsOf an estimated 3,490,245 hospitalizations, 78,003 (2.23%) required reexploration with decreasing incidence over time. Valvular procedures, preoperative intraaortic balloon pump use, and liver disease were associated with a greater likelihood of reexploration. Reoperation was associated with increased odds of mortality (adjusted odds ratio [AOR], 3.86; 95% confidence interval [CI], 3.61 to 4.12), perioperative complications, and resource use. Increasing time from index operation to reexploration was associated with higher odds of mortality (AOR,1.10/day; 95% CI, 1.07 to 1.12). High-performing hospitals were associated with lower odds of reexploration (AOR, 0.88; 95% CI, 0.82 to 0.95) and FTR-S (AOR, 0.29; 95% CI, 0.23 to 0.35). ConclusionsSurgical reexploration after cardiac surgery has declined over time. High-performing hospitals demonstrated lower rates of reexploration and subsequent FTR-S. Although unable to identify specific practices, this study highlights the presence of significant variation in takeback rates, and further study of underlying factors is warranted.