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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

Cliff K. Choonga,b,*, Caroline Gerrarda, Kimberley A. Goldsmitha, Helen Dunninghama,c, Alain Vuylstekea

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 {chi} 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




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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.