Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Semin Thorac Cardiovasc Surg. 2021 Autumn;33(3):764-773. doi: 10.1053/j.semtcvs.2020.11.013. Epub 2020 Nov 10.
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.
心脏手术后再次探查出血是一种术后并发症，与手术死亡率和短期发病率有关。然而，目前缺乏研究其长期影响的文献。因此，本研究旨在确定在一个大型同期患者队列中再次探查对长期死亡率的影响。这是一项对 2010 年至 2018 年期间在一家大型机构进行的开放心脏手术的观察性研究。确定了首次接受冠状动脉或瓣膜手术（胸外科医师协会索引手术）的患者。采用 Kaplan-Meier 生存估计和多变量 Cox 回归分析评估再次探查对生存的影响。为了隔离长期生存，排除了手术死亡率患者，并从出院日期开始计算生存时间，直到死亡日期。在 10824 例首次接受冠状动脉或瓣膜手术的患者中，有 292 例（2.7%）因出血而再次探查。排除手术死亡率患者并进行多变量风险调整后，与无需再次探查的患者相比，再次探查组的死亡风险显著增加（风险比 1.59，95%置信区间 1.21，2.09，P = 0.001）。此外，再次探查与 ICU 停留时间延长、总住院时间延长以及术后并发症增加有关，如通气时间延长、败血症、新的透析需求和新发心房颤动。心脏手术后因出血再次探查相关的发病率会持续到长期。该队列的长期生存较差是一个引人深思的发现，强调了心脏手术后过度出血的长期影响。
