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[Reoperation for bleeding following open heart surgery in Iceland]
Njáll Vikar Smárason1, Hannes Sigurjónsson, Kári Hreinsson
1Laeknadeild HI.
Insights
Postoperative bleeding after open heart surgery necessitates reoperation in 8% of cases, a rate higher than previously reported. This serious complication leads to significant morbidity and mortality in Icelandic patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Anesthesiology
Context:
- Postoperative bleeding is a significant complication following open heart surgery.
- Reoperation rates for bleeding typically range from 2-6% in existing literature.
- Surgical outcomes after reoperations for bleeding have not been previously studied in Iceland.
Purpose:
- To investigate the incidence and outcomes of reoperations for bleeding after open heart surgery in Iceland.
- To analyze patient demographics, perioperative factors, and postoperative complications associated with reoperations for bleeding.
Summary:
- A retrospective study analyzed 1295 open heart surgeries in Iceland (2000-2005), identifying 103 reoperations for bleeding (8% rate).
- Patients undergoing reoperation had a mean age of 68, 76% were male, and many had antiplatelet use prior to surgery.
- Common complications included atrial fibrillation, pleural effusion, myocardial infarction, and sternal wound infection, with a 15.5% operative mortality and 79.6% 1-year survival.
Impact:
- The study highlights a higher-than-expected reoperation rate for bleeding in Iceland, emphasizing its serious consequences.
- Findings underscore the significant morbidity and mortality associated with reoperations for postoperative bleeding after cardiac surgery.
- This research provides crucial data for improving patient management and outcomes in this specific surgical population.
Introduction:
Postoperative bleeding is a common and potentially fatal complication following open heart surgery, studies reporting a reoperation rate for bleeding in the range of 2-6%. Surgical outcome after such reoperations has not been previously studied in Iceland.
Material And Methods:
In this retrospective study were included all adults that underwent open heart surgery in Iceland during a 6 year period, between January 1, 2000 and December 31, 2005.
Results:
There were 103 reoperations (mean age 68 years, 76% males), but throughout the same 6 year period a total of 1295 open heart procedures were performed, the reoperation-rate being 8%. One third of all patients were on aspirin and 8% on clopidogrel less than 5 days before surgery. The bleeding in the primary operation averaged 1523 ml (range 300-4780) and 3942 ml for the first 24 hours postoperatively. Half of the patients were reoperated on within 2 h and 97% within 24 hours. The patients received on average 16.5 units of packed cells, 15.6 units of plasma and 2.3 sets of thrombocytes. The most common postoperative complication was atrial fibrillation (58.3%), pleural effusion that needed chest tube drainage (24.3%), myocardial infarction (23.3%) and sternal wound infection (11.7%). Median length of stay was 14 days (range 6-85), including 2 days (range 1-38) in ICU. Operative mortality was 15.5% and 1 year crude survival 79.6%.
Conclusion:
Reoperation-rate for bleeding was 8%, which is higher compared to other studies. Bleeding is a serious complication following open heart surgery with high morbidity and significant mortality.
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