Re-exploration due to bleeding is not associated with severe postoperative complications

In cardiac surgery, postoperative bleeding remains a frequent complication with various possible adverse outcomes. Re-exploration due to bleeding is frequent in this type of patient. Sternal wound infection is an infrequent but serious and devastating complication. Whether re-exploration due to bleeding significantly affects the incidence of sternal wound infection is uncertain. There is no consensus on allowed severity of bleeding and timing of intervention.

A retrospective, observational cohort study of 15 350 consecutive patients who underwent cardiac surgical procedures from 1 April 2006 through 31 December 2013 in 3 different university hospitals in Denmark was performed. Re-exploration due to postoperative bleeding occurred in 873 patients. To adjust for possible confounders, propensity score matching and logistic regression analyses were performed based on the centre, EuroSCORE I/II factors, extracorporeal circulation time, drugs affecting bleeding and coagulation, postoperative bleeding and units of blood transfusions. Patients were matched into 2 groups of 779 patients each for further analysis. The short-term outcomes were sternum infection, 30-day mortality and acute renal failure needing dialysis. The long-term outcome was the number of deaths 6 months after surgery.

The incidence of re-exploration was 5.7%. In the raw data, sternal infection was higher in the re-exploration group (2.4% vs 1.4; P = 0.020). After propensity score matching, no differences in sternal infection or other measured outcomes were found between the groups, either by crude or adjusted analyses.

Our study indicates that re-exploration is not associated with a higher frequency of severe postoperative complications. Probably the time of intervention for bleeding is important.