HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cliff K. Choong Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Choong, C. K. Articles by Vuylsteke, A. Search for Related Content PubMed PubMed Citation Articles by Choong, C. K. Articles by Vuylsteke, A. Related Collections Cardiac - other Coronary disease

Eur J Cardiothorac Surg 2007;31:834-838. doi:10.1016/j.ejcts.2007.02.001
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes

^a Papworth Hospital NHS Trust, Cambridge, United Kingdom
^b University of Cambridge, Cambridge, United Kingdom
^c Cambridge Perfusion Services, Papworth Hospital NHS Trust, Cambridge, United Kingdom

Received 19 October 2006; received in revised form 1 February 2007; accepted 2 February 2007.

^_* Corresponding author. Address: Papworth Hospital NHS Trust, Papworth Everard, Cambridge CB3 8RE, United Kingdom. Tel.: +44 1480 830541. (Email: cliffchoong{at}hotmail.com).

Objective: We aimed to identify the impact of re-exploration for bleeding after coronary artery bypass grafting (CABG) and the effect of time delay, re-exploration within 12 h (<12 h) versus 12 h or later (12 h). Methods: Analyses of prospective clinical data on 3220 consecutive patients who underwent CABG between 2003 and 2005 were performed. Pearson ² tests, Fisher's exact tests, Student's t-tests, Mann–Whitney U tests, or univariate logistic regression analysis were used to assess the effects of pre-operative and operative characteristics on re-exploration, and the effects of re-exploration and time delay on adverse outcomes. Predictors of re-exploration and its effect on adverse outcomes were further evaluated using multiple logistic regression analysis. Results: One hundred ninety-one patients (5.9%) underwent re-exploration for bleeding. Re-explored patients as a group in comparison to the non-re-explored group had increased postoperative blood loss, transfusion requirements, duration of mechanical ventilation, ICU stay, intra-aortic balloon pump (IABP) and haemofiltration support, and mortality (all p < 0.001). One hundred fifty-seven (82%) of the 191 patients were re-explored <12 h. The group of patients who were re-explored <12 h in comparison to 12 h group had shorter ICU stay (median 3 vs 8.5 days; p < 0.001), less IABP support (22.3 vs 44.1%; p = 0.009) and a lower mortality (7 vs 29.4%; p = 0.001). There was no significant difference in blood loss or transfusion requirements between the two groups. The predicted EuroSCORE risks of the <12 h group was 6.66% and the observed mortality was 7% (p = 0.865). The observed mortality of 29.4% in the 12 h group was significantly higher than the predicted EuroSCORE risks of 7.59% (p < 0.001). Conclusions: Patients requiring re-exploration for bleeding are at higher risk of adverse outcomes and this risk is increased if time to re-exploration is prolonged for 12 h or longer.

Key Words: Re-exploration • Coronary • Surgery • Bleeding

This article has been cited by other articles:

				S. G. Raja, H. Siddiqui, C. D. Ilsley, and M. Amrani In-hospital outcomes of off-pump multivessel total arterial and conventional coronary artery bypass grafting: single surgeon, single center experience. Ann. Thorac. Surg., July 1, 2009; 88(1): 47 - 52. [Abstract] [Full Text] [PDF]

				M. Ranucci, G. Bozzetti, A. Ditta, M. Cotza, G. Carboni, and A. Ballotta Surgical Reexploration After Cardiac Operations: Why a Worse Outcome? Ann. Thorac. Surg., November 1, 2008; 86(5): 1557 - 1562. [Abstract] [Full Text] [PDF]

				S. Yavuz, C. Eris, and T. Turk Re-exploration for excessive bleeding after coronary artery bypass surgery: how early is better? Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 819 - 820. [Full Text] [PDF]