Qazi Saddiq Mohammad, Kandler Kristian, Olsen Peter Skov
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark.
J Cardiovasc Thorac Res. 2021;13(3):198-202. doi: 10.34172/jcvtr.2021.34. Epub 2021 May 29.
Earlier studies have shown that re-operation for bleeding after cardiac surgery is associated with increased mortality and morbidity in both acute and elective patients. The aim of the study was to assess the effect of re-operation for bleeding on short- and long-term survival and the causes of re-operation on an exclusively elective population. This was a single-center, retrospective study conducted at the Department of Cardiothoracic Surgery at Copenhagen University Hospital. Rigshospitalet, Denmark. We included all elective patients undergoing first-time coronary bypass, valve surgery or combinations hereof between January 1998 and February 2014. Data was obtained from the electronic patient records on demographics, cardiological risk profile, blood transfusion and surgical record. A total of 11813 patients were included in the analysis of whom 626 (5.3%) patients underwent re-operation for bleeding. Patients were divided into two groups; non re-operated (NRO) and re-operated(RO). Baseline characteristics were comparable. Median survival was lover in the RO group (142 vs 160months ( = 0.001)). Morbidity and 30 day mortality was significantly higher in the RO group. Cox-regression analysis showed a significantly increased age-adjusted risk of death in the RO group (HR 1.21(1.07-1.37). = 0.003). In 85% of the patients the site of bleeding was found during the re-operation. We found both short and long-term survival to be lower in the RO group. A surgical cause for re-operation was found in the majority of cases. The study shows the importance of meticulous hemostasis during cardiac surgery.
早期研究表明，心脏手术后因出血进行再次手术与急性和择期手术患者的死亡率和发病率增加相关。本研究的目的是评估因出血进行再次手术对单纯择期手术人群短期和长期生存的影响以及再次手术的原因。这是一项在丹麦哥本哈根大学医院心胸外科进行的单中心回顾性研究。我们纳入了1998年1月至2014年2月期间所有首次接受冠状动脉搭桥术、瓣膜手术或两者联合手术的择期患者。数据从电子病历中获取，包括人口统计学、心脏风险概况、输血情况和手术记录。共有11813例患者纳入分析，其中626例（5.3%）患者因出血接受了再次手术。患者分为两组：未进行再次手术组（NRO）和进行再次手术组（RO）。基线特征具有可比性。RO组的中位生存期较低（142个月对160个月（P = 0.001））。RO组的发病率和30天死亡率显著更高。Cox回归分析显示，RO组年龄调整后的死亡风险显著增加（HR 1.21（1.07 - 1.37），P = 0.003）。在85%的患者中，再次手术时发现了出血部位。我们发现RO组的短期和长期生存率均较低。大多数病例中发现了再次手术的手术原因。该研究表明了心脏手术期间细致止血的重要性。
