Exploratory Laparotomy After Routine Cardiac Surgery: Results From 17,000 Patients

This study sought to elucidate the incidence and risk factors for exploratory laparotomy ("exlap") after cardiac surgery, its associated perioperative complications, and its impact on long-term survival.

This was an observational study of consecutive STS index cardiac operations between 2010-2022, excluding circulatory arrest, transplant, and multivalvular cases. The cohort was dichotomized by the incidence of exlap in the postoperative period.

A total of 17,362 patients were included, of which 77 (0.5%) underwent an exlap. Postoperatively, the exlap group required more intra-aortic balloon pumps (IABP), vasopressors, and rescue therapy (i.e., methylene blue or hydroxocobalamin) than the no-exlap group. The exlap group had higher operative mortality, stroke, prolonged ventilation, sepsis, dialysis, mediastinal re-exploration, and pRBC transfusions. On multivariable logistic regression, total number of postoperative pressors, use of rescue therapy, preoperative IABP, white race, chronic dialysis use, and history of cerebrovascular accident were associated with the need for postoperative exlap. On multivariable logistic regression, exlap was an independent risk factor for operative mortality (OR 3.67, 95% CI: 1.95-6.88, p < 0.001). Among patients surviving to discharge, Kaplan-Meier survival estimates were lower in the exlap group compared to the no-exlap group (p < 0.001), with 5-year survival being 58.9% (42.6-74.2) in the exlap group versus 84.4% (83.8-85.0) in the no-exlap group.

Exploratory laparotomy is rare after open-heart surgery, and it was performed for gastrointestinal complications that occurred in the context of other severe postoperative complications. Several factors were associated with the need for exlap, including increasing age, pre-existing renal and vascular disease, and pre- and post-operative shock.