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

Cliff K Choong¹, Caroline Gerrard, Kimberley A Goldsmith

¹Papworth Hospital NHS Trust, Cambridge, United Kingdom. cliffchoong@hotmail.com

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery

|March 16, 2007

Insights

Re-exploration for bleeding after coronary artery bypass grafting (CABG) increases adverse outcomes. Prompt re-exploration within 12 hours significantly reduces mortality and intensive care unit (ICU) stay compared to later intervention.

Area of Science:

Cardiovascular Surgery
Critical Care Medicine
Surgical Outcomes Research

Background:

Postoperative bleeding is a significant complication following coronary artery bypass grafting (CABG).
Re-exploration for persistent bleeding is a critical decision impacting patient outcomes.
The optimal timing for re-exploration remains a subject of clinical importance.

Purpose of the Study:

To evaluate the impact of re-exploration for bleeding after CABG.
To determine the effect of time delay on adverse outcomes following re-exploration.
To compare outcomes of early (<12 hours) versus late (≥12 hours) re-exploration.

Main Methods:

Analysis of prospective clinical data from 3220 consecutive CABG patients (2003-2005).
Statistical methods included chi-squared, t-tests, Mann-Whitney U, and logistic regression.
Evaluation of predictors for re-exploration and its effect on adverse outcomes.

Main Results:

5.9% of patients (191) underwent re-exploration for bleeding.
Re-explored patients had significantly higher blood loss, transfusion needs, ventilation duration, ICU stay, need for intra-aortic balloon pump (IABP) and hemofiltration, and mortality.
Early re-exploration (<12h) was associated with shorter ICU stay, less IABP use, and lower mortality compared to late re-exploration (≥12h).

Conclusions:

Patients requiring re-exploration for bleeding face elevated risks of adverse outcomes.
Prolonging the time to re-exploration beyond 12 hours significantly increases these risks, particularly mortality.

Read full analysis

Abstract

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 12h (<12h) versus 12h or later (>or=12h).

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 <12h. The group of patients who were re-explored <12h in comparison to >or=12h 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 <12h group was 6.66% and the observed mortality was 7% (p=0.865). The observed mortality of 29.4% in the >or=12h 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 12h or longer.

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