Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt.
J Cardiothorac Surg. 2021 Jun 7;16(1):166. doi: 10.1186/s13019-021-01545-4.
Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons.
To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management.
Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome.
Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality.
Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.
心脏手术后再次探查出血与较高的发病率和死亡率相关。围手术期出血量和再次探查率在各中心和外科医生之间存在差异。
介绍我们采用止血检查表和处理算法以实现较低再次探查率的经验。
对 2006 年 2 月至 2019 年 5 月期间因术后出血而接受先天性和获得性心脏病手术治疗的 565 例成年患者的病历进行回顾性分析。记录患者的人口统计学、手术特征、围手术期危险因素、出血量、输血需求、发病率和死亡率。采用逻辑回归分析确定再次探查的预测因素和不良结局的决定因素。
13 例（1.14%）患者因出血而再次探查。11 例（84.6%）患者发现明确的出血源。再次探查的危险因素包括高体重指数、高 Euro SCORE、手术优先级（紧急/紧急）、血清肌酐升高和血小板计数降低。再次探查与输血需求增加、心肺状态不良（射血分数降低、血清乳酸增加和机械通气时间延长）、重症监护病房停留时间、住院时间延长、SWI 发生率增加以及死亡率升高（15.4%与非再次探查患者的 2.53%）显著相关。我们根据我们的方案通过止血剂对 285 例严重或大量出血患者进行了保守治疗，没有增加发病率或死亡率的风险。
通过严格的术前准备、高级外科医生实施的术中止血检查表和采用处理算法，可以实现较低的再次探查出血率。
