Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac208.
Excessive bleeding leading to re-exploration is a severe complication of cardiac surgical procedures, associated with early postoperative morbidity and mortality. Less is known about the long-term outcome of these patients. We evaluated the impact of re-exploration after cardiac surgery on peri- and postoperative morbidity and mortality, as well long-term mortality, in a well-defined nationwide population.
In this retrospective study, 48 060 consecutive patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery from 2006 to 2015 were analysed. Multivariable logistic regression was used to identify factors associated with re-exploration, morbidity and mortality. Cox regression analysis was implemented to explore the association between re-exploration and long-term mortality. The mean follow-up time was 4.6 years (range 0-10 years) with follow-up time set at 31 December 2015.
Overall, 2371 patients (4.9%) underwent re-exploration. Factors associated with re-exploration included advanced age, procedures other than isolated CABG and acute surgery. Re-explored patients had an increased risk of unadjusted mortality at 30, 90 and beyond 90 days (all P < 0.001). Significance was maintained after adjustment at 30 days [odds ratio: 3.94, 95% confidence interval (CI): 3.19-4.85, P < 0.001] and 90 days (odds ratio: 3.79, 95% CI: 3.14-4.55, P < 0.001), but not with long-term mortality (hazard ratio: 1.02, 95% CI: 0.91-1.15, P = 0.712). Furthermore, re-exploration was independently associated with other postoperative complications, e.g. prolonged hospital stay, stroke and renal injury.
Patients who are re-explored for bleeding within 24 h have almost four-fold higher odds of mortality within 3 months post-procedure. However, the increased risk of death following re-exploration is not maintained in the long term.
导致再次探查的过度出血是心脏外科手术的严重并发症，与术后早期发病率和死亡率相关。关于这些患者的长期结果了解较少。我们评估了心脏手术后再次探查对围手术期发病率和死亡率以及长期死亡率的影响，这是在一个明确的全国范围内人群中进行的。
在这项回顾性研究中，分析了 2006 年至 2015 年间连续接受冠状动脉旁路移植术（CABG）和/或瓣膜手术的 48060 例患者。多变量逻辑回归用于确定与再次探查、发病率和死亡率相关的因素。实施 Cox 回归分析以探讨再次探查与长期死亡率之间的关系。平均随访时间为 4.6 年（0-10 年），随访时间截止至 2015 年 12 月 31 日。
总体而言，2371 例患者（4.9%）接受了再次探查。与再次探查相关的因素包括年龄较大、非孤立性 CABG 和急症手术。接受再次探查的患者在未调整的 30、90 天和 90 天以上的死亡率风险增加（均 P < 0.001）。调整后 30 天[优势比：3.94，95%置信区间（CI）：3.19-4.85，P < 0.001]和 90 天[优势比：3.79，95% CI：3.14-4.55，P < 0.001]的意义仍然显著，但与长期死亡率无关（风险比：1.02，95% CI：0.91-1.15，P = 0.712）。此外，再次探查与其他术后并发症独立相关，例如住院时间延长、中风和肾功能损伤。
在 24 小时内因出血而再次探查的患者在术后 3 个月内死亡的几率几乎增加了四倍。然而，再次探查后死亡的风险增加在长期内并不持续。
