Early reexploration for excessive postoperative bleeding lowers wound complication rates in open heart surgery

Clinical reviews of sternal wound infections following open heart surgery indicate many predisposing factors including diabetes, low cardiac output, use of bilateral internal mammary grafts, and reoperation for excessive postoperative bleeding. This study was undertaken to determine the role of mediastinal re-exploration in the development of sternal wound complications. From a series of 2,271 patients undergoing median sternotomy for open-heart surgery between 1979 and 1984, 71 (3.1%) were re-explored for excessive bleeding. Nine of these patients died in the early postoperative period of noninfectious complications. The remaining patients were divided into two groups. Group 1 (54 patients) were re-explored without subsequent problems. Group 2 (8 patients) developed sternal and costochondral wound complications. Comparison of age, intercurrent and pre-existing disease, total bypass time, crossclamp time, and postoperative hemodynamic status showed no statistical difference. All patients bled an average rate of 247 ml/hr. However, the average time before re-exploration was 7.6 hours in group 1 compared to 13.8 hours in group 2 (P less than 0.001). Sternal wound complications may be minimized by a policy of early re-exploration for excessive postoperative bleeding (greater than 200 ml/hr for 4 hours).