Early Reexploration for Bleeding Is Associated With Improved Outcome in Cardiac Surgery.

Autor:	Shou BL; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Aravind P; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Ong CS; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Alejo D; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Canner JK; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Etchill EW; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., DiNatale J; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Prokupets R; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Esfandiary T; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Lawton JS; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Schena S; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: sschena1@jhmi.edu.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2023 Jan; Vol. 115 (1), pp. 232-239. Date of Electronic Publication: 2022 Aug 08.
DOI:	10.1016/j.athoracsur.2022.07.037
Abstrakt:	Background: Reexploration after cardiac surgery, most frequently for bleeding, is a quality metric used to assess surgical performance. This may cause surgeons to delay return to the operating room in favor of attempting nonoperative management. This study investigated the impact of the timing of reexploration on morbidity and mortality. Methods: This study was a single-institution retrospective review of all adult cardiac surgery patients from July 2010 to June 2020. Time to reexploration was assessed, and outcomes were compared across increasing time intervals. Reported bleeding sites were classified into 5 groups, and bleeding rate (chest tube output) was compared across bleeding sites. Univariable analysis was performed using the Fisher exact and Kruskal-Wallis tests. Multivariable logistic regression models were used for risk-adjusted analyses. Results: Of 10 070 eligible patients, 251 (2.5%) required reexploration for postoperative bleeding. The most common site of bleeding was "any suture line" (n = 70; 28%). Interestingly, in 30% of cases (n = 75) "no active bleeding" site was reported. The highest rate of bleeding (mL/h) was observed in the "any mediastinal structure" group (median, 450; interquartile range [IQR], 185, 8878), and the lowest rate was noted in the "no active bleeding" group (median, 151.2; IQR, 102, 270). Both morbidity rates (0-4 hours, 12.3% vs 25-48 hours, 37.5%; P = .001) and mortality rates (0-4 hours, 3.1% vs 25-48 hours, 43.8%; P = .001) escalated significantly with increasing time to reexploration. Conclusions: Delayed reexploration for bleeding after cardiac surgery is associated with increased risk for morbidity and mortality. Early surgical intervention, particularly within 4 hours, may improve outcomes. Implications from using reoperation as a performance metric may lead to unnecessary delay and patient harm. (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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