Long-Term Outcomes of Reoperation for Bleeding After Cardiac Surgery

Re-exploration for excessive bleeding after cardiac surgery is a postoperative complication that has been associated with operative mortality and short-term morbidity. However, there is dearth of literature examining its long-term impact. Thus, this study sought to determine the impact of reexploration on long-term mortality in a large, contemporaneous cohort of patients. This was an observational study of open cardiac surgeries between 2010 and 2018, at a single large institution. Patients undergoing first time coronary or valvular surgery (Society of Thoracic Surgeons indexed operations) were identified. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of re-exploration on survival. To isolate long-term survival, patients with operative mortality were excluded and survival time was counted from the date of discharge until the date of death. Of the 10,824 patients undergoing first time coronary or valvular surgery, 292 (2.7%) were reexplored for bleeding. After excluding patients with operative mortality and after multivariable risk-adjustment, the reexploration group remained at significantly increased risk of death, as compared to the group not requiring re-exploration (hazards ratio 1.59, 95% confidence interval 1.21, 2.09, P = 0.001). Moreover, re-exploration was associated with longer intensive care unit stay, longer total length of hospital stay, as well as increased postoperative complications, such as prolonged ventilation, sepsis, new dialysis requirement, and new onset atrial fibrillation. The morbidity associated with re-exploration for bleeding after cardiac surgery extends into the long-term. This cohort's worse long-term survival is a provocative finding that highlights the long-term impact of excessive bleeding after cardiac surgery.