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Low Fibrinogen Is Associated with Increased Bleeding-Related Re-exploration after Cardiac Surgery
Yasin Essa1, Natig Zeynalov1, Tim Sandhaus1
1Department of Cardiothoracic Surgery, Friedrich Schiller University of Jena, Jena, Germany.
Insights
Low fibrinogen levels increase the risk of re-exploration after cardiac surgery. This complication is linked to higher mortality and morbidity, highlighting the importance of monitoring fibrinogen.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Critical Care Medicine
Background:
- Re-exploration after cardiac surgery is a frequent complication with significant negative outcomes.
- Identifying risk factors for re-exploration is crucial for improving patient prognosis.
Purpose of the Study:
- To identify risk factors associated with re-exploration following cardiac surgical procedures.
- To investigate the relationship between perioperative fibrinogen levels and the need for re-exploration.
Main Methods:
- Retrospective review of 2,403 cardiac surgery patients (2013-2014).
- Analysis of 42 patients requiring re-exploration, matched with a control cohort.
- Exclusion of patients with oral anticoagulation, infective endocarditis, or identified bleeding sources.
Main Results:
- Patients requiring re-exploration had lower preoperative plasma fibrinogen (2.8 vs. 3.6 g/L).
- Re-explored patients received more packed red blood cells and had higher postoperative lactate levels.
- Lower plasma fibrinogen upon ICU arrival independently predicted postoperative bleeding.
Conclusions:
- Low perioperative plasma fibrinogen concentration is a significant risk factor for bleeding and re-exploration in cardiac surgery patients.
- Re-exploration is associated with increased morbidity and mortality in this patient group.
Background:
Re-exploration after cardiac surgery remains a relatively frequent complication associated with adverse effects on outcome. We aimed to identify risk factors for re-exploration.
Methods:
We retrospectively reviewed 2,403 patients having undergone cardiac surgical procedure between January 2013 and December 2014. Re-exploration was required in 114 patients (4.7%). Patients with oral anticoagulation, infective endocarditis, or a clearly identified bleeding source were excluded. Therefore, 42 patients remained for analysis. A matched cohort was selected for age, sex, ejection fraction, creatinine, and procedure out of the non-re-explored patients.
Results:
Demographic data were similar in both groups, except for a higher prevalence of diabetes (45 vs. 21%; p = 0.036) in the non-re-explored patients. Surgery was elective in two-thirds and preoperative plasma fibrinogen concentration was lower in patients requiring re-exploration (2.8 ± 0.9 vs. 3.6 ± 0.9 g/L; p = 0.002). During the initial operation, re-explored patients received more packed red blood cells (1.5 ± 3 vs. 0 ± 1 units; p < 0.001), Postoperatively, re-explored patients had higher lactate levels (1.7 ± 1.4 vs. 1.3 ± 0.6 mmol/L, p = 0.044), more chest tube drainage (1,245 ± 948 vs. 685 ± 413 mL; p < 0.001), higher hospital mortality (19 vs. 7%; p = 0.19), and longer intensive care unit (ICU) stays (8 ± 8 vs. 4 ± 7 days; p = 0.010). In addition, more fibrinogen was administrated during the initial surgery. Plasma fibrinogen concentration upon arrival at the ICU was lower in patients requiring re-exploration (2 ± 0.6 vs. 2.7 ± 0.7 g; p < 0.001). Multivariable linear regression analysis identified fibrinogen upon arrival at the ICU as an independent predictor of postoperative bleeding.
Conclusion:
Cardiac surgery patients with low perioperative plasma fibrinogen concentration appear to be more susceptible to bleeding and re-exploration. Re-exploration in this group of patients is associated with increased morbidity and mortality.
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