Reoperation in the intensive care unit.

From July 1, 1984, through June 30, 1989, after 1,259 open heart operations, 110 patients (8.7%) underwent 162 early reoperations either in the intensive care unit (144 procedures) or in the operating room (26 procedures). Reexploration for bleeding (49 procedures) (3.9%) and intraaortic balloon removal (50 procedures) (4.0%) were the two most common procedures. Ninety percent and 96% of these procedures, respectively, were performed in the intensive care unit. Mediastinal infections occurred in 4 (6.1%) of 66 patients undergoing repeat mediastinal operations for all indications. No infection occurred after reexploration for bleeding nor did mediastinal infection occur after reoperation in the intensive care unit. Postoperative death in these 110 patients was not related to reoperation except possibly in the case of 1 patient (0.9%). Average transit time to and from the operating room for patients returned there for reoperation was 89.7 minutes. Charges for procedures performed in the operating room were at least twice as great as for those performed in the intensive care unit. This experience supports expanded use of reoperation in the intensive care unit, as it is safe, effective, economical, and convenient.